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DEATH
CERTIFICATE
WILLARD MILLER
Date 04 February 1944
Cert: 11111
Place of Death: County: Perry City or
Town: Hazard Hospital
Name of Hospital or Institution: (blank)
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Anco
Full Name: Willard MILLER
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: (blank)
Age: 18 days
Birthplace: (blank)
Occupation: (blank)
Industry or business: (blank)
Father Name: Newt MILLER
Father Birthplace: Ky.
Mother Maiden Name: Anna OWENS
Mother Birthplace: Ky.
Informant: Anna MILLER, Anoc, Ky.
Burial Place: Dwarf, Ky.
Date: February 1944
Signature of funeral director: (blank)
Date received by local registrar: 30 March 1945 [sic]
Registrar's Signature: Anna L. Boulos by (illegible)
Date of Death: 04 February 1944
I hereby certify that I attended deceased from 04 February
1944 to
04 February 1944, that I
last saw him alive on 04 February 1944, and that death occurred on the date
stated above at 10:30 a.m.
Immediate cause of death: Congenital heart disease
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 09 February 1944
Transcribed by Debbie Tamborski, 08 February 2010 |
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