Date:   05 January 1941
Cert:   02294 
Place of Death: County: Knott     City or Town: Mousie
Street No. or location:  Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Mousie, Ky.     Street No.:  Rural
Full Name: Charlie HICKS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  16 February 1854
Age: 86 years
Birthplace:  Perry Co.
Occupation:  (blank)
Industry or business: (blank)
Father Name:  Kalip HICKS
Father Birthplace:  Va.
Mother Maiden Name:  Sallie MCKINNEY
Mother Birthplace:  Va.
Informant:  W. L. HICKS, Mousie, Ky.
Burial Place:  Mousie
Date:  07 January 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar:  23 January 1941
Registrar's Signature:  Macie Miller
Date of Death:  05 January 1941
I hereby certify that I attended deceased from 20 June 1940 to 05 January 1941, that I last saw him alive on 05 January 1941, and that death occurred on the date stated above at 11:10 p.m.
Immediate cause of death:  Paralysis
Duration: (blank)
Due to: Senility
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 & Address:  Dr. M. M. Collins, M.D., Lackey, Ky.
Date signed:  (blank)
Transcribed by Debbie Tamborski, 12 October 2010