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DEATH
CERTIFICATE
HOBERT HICKS
Date 19 August 1941
Cert: 20842
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural #4
Full Name: Hobert HICKS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 31 July 1939
Age: 02 years, 19 days
Birthplace: Perry Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Mack HICKS
Father Birthplace: Perry Co.
Mother Maiden Name: Rebecca BOWLING
Mother Birthplace: Perry Co., Ky.
Informant: Mack HICKS, Anco, Ky.
Burial Place: Bowling Town
Date: 20 August 1941
Signature of funeral director: Engle Und. & Hdw.,
Co., Hazard, Ky.
Date received by local registrar: 04 September 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 19 August 1941
I hereby certify that I attended deceased from 19 August 1941 to
19 August 1941, that I
last saw him alive on 19 August 1941, and that death occurred on the date
stated above at 7:05 p.m.
Immediate cause of death: Bacillary dysentery
Due to: (blank)
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 04 September 1941
Transcribed by Debbie Tamborski, 01 February 2010 |
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