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DEATH
CERTIFICATE
JACK HURT
Date 29 March 1932
Cert: 10004
Place of Death: Voting Pct. No. 25, Hazard Hospital Co.,
Hazard, Perry Co., Ky.
Full Name: Jack HURT
Residence: Hindman, Ky.
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: (blank)
Age: 01 years
Occupation: None
Birthplace: Knott Co.
Father Name: Alonzo HURT (not known also
written in this section)
Birthplace Father: Fisty (not
known also written in this section)
Mother Maiden Name: Grace CALHOUN
(not known also written in this section)
Birthplace Mother: Hindman, Ky. (not
known also written in this section)
Informant/Address: (blank)
Burial Cremation Removal Place: (blank)
Date: (blank)
Undertaker/Address: Ideal Furniture Co., Hazard, Ky.
Filed: 01 May 1932
Registrar: J. P. Boggs
Death of Date:
I hereby certify, That I attended deceased from 29 March 1932 to
29 March 1932, that I last saw him alive on 29 March 1932,
death is said to have occurred on the date stated above, at
11:35 p.m.
Cause of Death: Bronchial pneumonia
Date of onset: (blank)
Contributory causes: Gastroenteritis
Name of operation: none
Date of: (blank)
What test confirmed diagnosis: Clinical
Was there an autopsy: No
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: J. E. Hagan, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 31 March 2010 |
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