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DEATH
CERTIFICATE
FARRIS MOORE
Date 01 November 1949
Cert: 23832
Place of Death: County: Oldham City or
Town: LaGrange
Name of Hospital or Institution: Kentucky State
Reformatory
Length of stay in hospital or community: 08 Mos.
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Handshoe
Street No.: Unknown
Full Name: Farris MOORE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Ellen MOORE
Age of husband or wife if alive: (blank)
Birth date of deceased: 1918
Age: 31 years
Birthplace: Knott County Kentucky
Occupation: Laborer
Industry or business: Sanford Griffin Coal Co.
Father Name: Jasper Moore
Father Birthplace: Unknown
Mother Maiden Name: Unknown (Deceased)
Mother Birthplace: Unknown
Informant: Prison Records, Kentucky State Reformatory
Burial Place: Burial Knott Co.
Date: 03 November 1949
Signature of funeral director: (illegible) Funeral Home
Date received by local registrar: 01 November 1949
Registrar's Signature: Scott S. Smith
Date of Death: 01 November 1949
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on approximately 5:00 a.m.,
and that death occurred on the date stated above at 01
November 1949
Immediate cause of death: (blank)
Due to: Myocarditis (Sudden)
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: Ken Gividen, Box 188, LaGrange, Ky.
Date signed: 01 November 1949
Transcribed by Debbie Tamborski, 15 February 2010 |
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