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DEATH
CERTIFICATE
WILLIAM MALCOLM HORN
Date 14 July 1917
Cert: 19300
Place of Death: Voting Precinct: Middle Creek, Floyd
Co., Ky.
Full Name: William Malcolm HORN
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: (blank)
Age: 38 years
Occupation: Coal Miner
Birthplace: Knott Co., Ky.
Name of Father: Riley HORN
Birthplace Father: Johnson Co., Ky.
Maiden name of Mother: Mary CALHOUN
Birthplace Mother: Knott Co., Ky.
Informant/Address: James HORN, Prestonsburg
Filed: 08 August 1917
Registrar: (blank)
Death Date: 14 July 1917
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: Slate falling on him in mine and broke
back
Duration: 07 months
Contributory: (blank)
Signed/Address: (blank)
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Whitaker G. Y.
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 28 February 2010 |
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