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DEATH
CERTIFICATE
ADAM MILLER
Date 24 February 1936
Cert: 09014
Place of Death: Voting Pct.: No. 30, Hazard Hospital
Co., Hazard, Perry Co., Ky.
Full Name: Adam MILLER
Residence: Hindman, Ky.
Length of Residence: 20 years
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 10 December 1911
Age: 24 years, 02 months, 14 days
Occupation: CCC Enrolle
Birthplace: Knott County Kentucky
Father Name: Jack MILLER
Birthplace Father: Breathitt Co., Ky.
Mother Maiden Name: Adeline TERRY
Birthplace Mother: Knott Co., Kentucky
Informant/Address: Jack MILLER, Hindman, Ky.
Burial Cremation Removal Place: Vest, Ky.
Date: (blank)
Undertaker/Address: Engle Bros., Ky.
Filed: 31 March 1936
Registrar: J. P. Boggs
Death of Date: 24 February 1936
I hereby certify, That I attended deceased from 20 February
1936 to
24 February 1936, that I last saw him alive on 24 February
1936, death is said to have occurred on the date stated above,
at 3 a.m.
Cause of Death: Bilateral lobar pneumonia
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: None
What test confirmed diagnosis: Clinical
Was there an autopsy: No
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. Hagen, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 21 April 2010 |
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