Date:   26 August 1941
Cert:   29461
Place of Death: County: Knott     City or Town: Lackey
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: (blank)  County: (blank)
City or Town:  Melvin, Kentucky
Full Name:  Jerry David HATFIELD
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of:  Mabel HATFIELD
Age of husband or wife if alive:  (blank)
Birth date of deceased:  23 April 1890
Age: 51 years, 04 months, 03 days
Birthplace:  Pike County, Ky.
Occupation:  Merchant
Industry or business: General Store, etc.
Father Name:  Orrison HATFIELD
Father Birthplace: unknown 
Mother Maiden Name:  Elizabeth ADAMS
Mother Birthplace:  (blank)
Informant:  Add THACKER, Bypro, Ky.
Burial Place:  Piketon
Date:  29 August 1941
Signature of funeral director:  J. L. Malone, Bypro, Ky.
Date received by local registrar:  03 September 1941
Registrar's Signature:  Phena Slone
Date of Death:  26 August 1941
I hereby certify that I attended deceased from 25 July 1941 to 26 July 1941, that I last saw him alive on 26 July 1941, and that death occurred on the date stated above at 7:45 p.m.
Immediate cause of death:  Inter-cranial hemorrhage
Duration: (blank) 
Due to: Peptic ulcer
Other conditions:  (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: W. L. Stumbo, M.D., Lackey, Ky.
Date signed:  (blank)
Transcribed by Debbie Tamborski, 12 October 2010