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DEATH
CERTIFICATE
JOHNNIE JOHNSON
Date 16 December 1940
Cert: 09701
Place of Death: County: Floyd City or Town:
Bevinsville
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Knott
Co.
City or Town: Pippapass
Full Name: Johnnie JOHNSON
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: 17 April 1917
Age: 23 years, 07 months, 30 days
Birthplace: Floyd Co.
Occupation: Taxi Driver
Industry or business: (blank)
Father Name: Willard JOHNSON
Father Birthplace: Bevinsville, Ky.
Mother Maiden Name: Larcy JOHNSON
Mother Birthplace: Jacks Creek, Ky.
Informant: Taylor WATSON, Pippapass, Ky., (Knott Co.)
Burial Place: Halo, Ky.
Date: 18 December 1940
Signature of funeral director: none
Date received by local registrar: 08 April 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 16 December 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I
last saw him alive on (blank), and that death occurred on the date
stated above at (blank)
Immediate cause of death: Pulmonary Tuberculosis
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: J. W. Duke, M.D., Hindman, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 01 February 2010 |
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