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DEATH
CERTIFICATE
JOHN PAUL HORMON
Date 20 January 1940
Cert: 01960
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: Kentucky County:
Floyd
City or Town: Weeksberry, Ky.
Full Name: John Paul HORMON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 August 1937
Age: 02 years
Birthplace: Weeksberry
Occupation: (blank)
Industry or business: (blank)
Father Name: John HORMON
Father Birthplace: Williamsport, Ky.
Mother Maiden Name: Carrie JACKSON
Mother Birthplace: Portsmouth, O
Informant/Address: John HORMON, Weeksberry, Ky.
Burial Place: Williamsport, Ky.
Date: (blank)
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 20 January 1940
I hereby certify that I attended deceased from 20 January 1940 to
20 January 1940, that I last saw him alive on 20 January 1940, and that death
occurred on the date stated above at 4:00 p.m.
Immediate cause of death: Bronchial pneumonia
Duration: 03 days
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 & Address: C. B. Ison, Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 18 August 2010 |
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