|
DEATH
CERTIFICATE
CANN MOORE
Date 28 July 1930
Cert: 18182
Place of Death: Voting Pct: Hurst-Snyder Hospital,
Hazard, Ky.
Full Name: Cann MOORE
Residence: (blank)
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 10 July 1910
Age: 20 years, 00 months, 18 days
Occupation: Farmer, at home
Birthplace: Vest, Ky.
Father Name: Morell MOORE
Birthplace Father: Floyd Co., Ky.
Mother Maiden Name: Judie PRATER
Birthplace Mother: Vest, Ky.
Informant/Address: George MOORE, Vest, Ky.
Filed: 11 August 1930
Registrar: J. P. Boggs
Death of Date: 28 July 1930
I hereby certify that I attended deceased from 25 July 1930 to
28 July 1930, that I last saw him alive on 28 July 1930, and
that death occurred on the date stated above at 6 a.m.
Cause of Death: Gunshot wound self inflicted
Duration: (blank)
Contributory: (blank)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: Taylor Hurst, M.D., 28 July 1930, Hazard, Ky.
Place of Burial or Removal: Knott Co., Vest, Ky.
Date of Burial: (blank)
Undertaker/Address: Ideal Furn. Co., Hazard, Ky.
Transcribed by Debbie Tamborski, 29 March 2010 |
|