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DEATH
CERTIFICATE
CHARLES MOORE
Date 07 June 1949
Cert: 19482
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community: (blank)
Name of Hospital or Institution: Mt. Mary Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Wiscoal, Ky.
Full Name: Charles MOORE
Date of Death: 07 June 1949
Sex, Color or Race, Marital Status: Male, White, Widowed
Date of Birth: 12 June 1907
Age: 42 years
Usual Occupation: Miner
Kind of Industry or business: Mines
Birthplace: Bath, Ky.
Father's Name: John MOORE
Mother's Maiden Name: Jane MULLINS
Was deceased in ever in armed forces: No
Social Security No.: 401-14-0548
Informant: Nord MOORE
Disease/condition directly leading to death: cerebral
hemorrhage
Interval between onset and death: 10 days
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings for operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from (blank) to
(blank), that I
last saw the deceased alive on (blank), and that death occurred on
the date stated above at (blank), from the causes and on the date
stated above.
Date signed: (blank)
Address: (blank)
Signature: Martin Palmer, M.D.
Burial, Cremation or Removal: Burial
Date: 09 June 1949
Name of Cemetery or Creamatory: Combs Cemetery
Location: Amburgey, Ky.
Date received by local registrar: 03 October 1949
Registrar's Signature: Georgia Pendleton
Funeral director and address: Maggard and Garrett, Hazard, Ky.
Transcribed by Debbie Tamborski, 15 February 2010 |
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