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DEATH
CERTIFICATE
CASEY JONES
Date 31 July 1941
Cert: 16956
Place of Death: County: Floyd City or Town:
Martin, Ky.
Street No. or Location: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Floyd
City or Town: Martin, Ky.
Full Name: Casey JONES
If Veteran Name War: (blank)
Social Security No.: 403-01-1182
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: 24 November 1913
Age: 27 years, 08 months, 07 days
Birthplace: Knott Co., Ky.
Occupation: Coal Miner
Industry or business: (blank)
Father Name: Lee JONES
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Roxie SLOAN
Mother Birthplace: Knott Co., Ky.
Informant: Roxie CHAMBRS, Martin, Ky.
Burial Place: Dema
Date: 03 August 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar: 31 July 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 31 July 1941
I hereby certify that I attended deceased from 31 July 1941 to
31 July 1941, that I last saw h-- alive on 31 July 1941, and
that death occurred on the date stated above at 8:10 a.m.
Immediate cause of death: Crushing injury to chest &
abdomen
Duration: (blank)
Due to: Run over by mining car
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 31 July 1941
Where did injury occur: Industrial place
While at work: yes
Means of injury: Crushed chest
Signature & Address: Edward R. Coddin, M.D., Martin,
Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 13 May 2010 |
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