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DEATH
CERTIFICATE
BURWOOD HAYS
Date 30 November 1953
Cert: 27440
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community: (blank)
Name of Hospital or Institution: Mt. Mary Hosp.
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Hindman
Full Name: Burwood HAYS
Date of Death: 30 November 1953
Sex, Color or Race, Marital Status: Male, White, No
[sic]
Date of Birth: 10 October 1908
Age: 45 years
Usual Occupation: (blank)
Kind of Industry or business: none
Birthplace: Knott Co., Ky.
Father's Name: Thomas HAYS
Mother's Maiden Name: Margret HAYS
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Bud HAYS
Disease or condition directly leading to death: Head
injury chest injury
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Accident, suicide, or homicide: auto accident
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from (blank) to
(blank), that I
last saw the deceased alive on (blank), and that death occurred on
the date stated above at (blank), from the causes and on the date
stated above.
Date signed: 14 March 1954
Address: Hazard
Signature: E. P. Boggs, M.D.
Burial, Cremation or Removal: Burial
Date: 02 December 1953
Name of Cemetery or Creamatory: Green Gayheart Cem.
Location: Hindman, Ky.
Date received by local registrar: 26 August 1954
Registrar's Signature: R. F. Johnson by Georgia P. Surer
Funeral director and address: John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 21 February 2010 |
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