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DEATH
CERTIFICATE
J. A. MILLARD
Date 06 December 1940
Cert: 03119
Place of Death: County: Perry City or Town:
Hurst Snyder Hospt.
Name of Hospital or Institution: Hazard, Ky.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural
Full Name: J. A. MILLARD
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Birth date of deceased: (blank)
Age: 15 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Add MILLARD
Father Birthplace: Knott Co.
Mother Maiden Name: Virgie CORNETT
Mother Birthplace: Perry Co.
Informant: Wattson CORNETTE, Vico, Ky.
Burial Place: Daisy, Ky.
Date: 07 December 1940
Signature of funeral director: Engle and (illegible),
Hazard, Ky.
Date received by local registrar: 29 January 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 06 December 1940
I hereby certify that I attended deceased from 15
November 1940 to 06 December 1940, that I last saw him alive on
06 December 1940, and that death occurred
on the date stated above at 4:45 p.m.
Immediate cause of death: Cellulitis of Neck
Due to: Peritonsilar abscess
Major findings of operations: Incision & drainage
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: R. Smith Howard, M.D., Slemp, Ky.
Date signed: 17 December 1940
Transcribed by Debbie Tamborski, 30 January 2010 |
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