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DEATH
CERTIFICATE
MILES MARTIN
Date 14 January 1942
Cert: 04752
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Wiscoal
Full Name: Miles MARTIN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Beulah MARTIN
Age of husband or wife if alive: 33 years
Birth date of deceased: 23 October
Age: 35 years
Birthplace: Ala.
Occupation: Miner
Industry or business: Mining
Father Name: Newton MARTIN
Father Birthplace: Ala.
Mother Maiden Name: Florence (illegible)
Mother Birthplace: Ala.
Informant: (blank)
Burial Place: Engle(illegible)
Date: 16 January 1942
Signature of funeral director: Engles, Hazard
Date received by local registrar: 26 January 1942
Registrar's Signature: (blank)
Date of Death: 14 January 1942
I hereby certify that I attended deceased from 13 January 1942 to
14 January 1942, that I
last saw him alive on 14 January 1942, and that death occurred on the date
stated above at 1:30 p.m.
Immediate cause of death: Fractured Cervical Spine
Due to: Mine injury
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 13 January 1942
Where did injury occur: Coal mine
While at work: yes
Means of injury: (blank)
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 20 January 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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