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DEATH
CERTIFICATE
JOHN M. HARRIS
Date 30 September 1944
Cert: 23043
Place of Death: County: Laurel City or
Town: London
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: 05 yrs.
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Anco (Rural)
Full Name: John M. HARRIS
If Veteran Name War: World War I
Social Security No.: 404-09-0827
Sex, Color or Race, Marital Status: Male, White, Divorced and
Married
Husband or Wife of: Lena HARRIS
Age of husband or wife if alive: 45 years
Birth date of deceased: 17 December 1894
Age: 49 years, 09 months, 13 days
Birthplace: Laurel County, Ky.
Occupation: Miner
Industry or business: Coal Mines
Father Name: William HARRIS
Father Birthplace: Laurel Co., Ky.
Mother Maiden Name: Samantha TIGNE
Mother Birthplace: Laurel Co., Ky.
Informant: Lena HARRIS, Anco, Ky.
Burial Place: Englewood Cemetery
Date: 02 October 1944
Signature of funeral director: House Funeral Home, London, Ky.
Date received by local registrar: October 1944
Registrar's Signature: (blank)
Date of Death: 30 September 1944
I hereby certify that I attended deceased from 17 September
1944 to
19 September 1944, that I
last saw him alive on 19 September 1944, and that death occurred on the date
stated above at 8:00 a.m.
Immediate cause of death: Heart failure
Due to: Angina Pectoris
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: J. R. Aker, M.D., Anco, Ky.
Date signed: 05 October 1944
Transcribed by Debbie Tamborski, 08 February 2010 |
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