Date:    02 October 1947
Cert:    28500 
Place of Death: County: Knott   City or Town:  Lackey
Name of Hospital or Institution: Stumbo Mem. Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.     County:  Floyd
City or Town:  Wayland 
Full Name:  Fieldery MOORE 
If Veteran Name War: (blank)
Social Security No.:  (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of:  Berly MOORE
Age of husband or wife if alive: 32 years
Birth date of deceased:  26 June 1906 
Age:  41 years, 03 months, 06 days
Birthplace:  Floyd Co., Ky. 
Occupation:  Miner (Coal) 
Industry or business:  (blank)
Father Name:  Harrison MOORE 
Father Birthplace:  Floyd Co., Ky. 
Mother Maiden Name:  Mandy COLLINS 
Mother Birthplace:   Floyd Co., Ky. 
Informant:   Hawk MOORE, Wayland, Ky. 
Burial Place:   Wayland, Ky. 
Date:  03 October 1947 
Signature of funeral director:  W. J. Ryan, Martin, Ky.
Date received by local registrar: 13 January 1948 
Registrar's Signature:  Rose B. Craft
Date of Death:  02 October 1947 
I hereby certify that I attended deceased from 28 September 1947 to 02 October 1947, that I last saw him alive on 02 October 1947, and that death occurred on the date stated above at 7:30 a.m.
Immediate cause of death:  Respiratory failure
Duration: (blank)
Due to:  Gunshot wound left chest
Major findings of operations: pneumothorax and hemothorax
Accident, suicide, or homicide: Suicide
Date of occurrence: 28 September 1947
Where did injury occur: at home
While at work:  (blank)
Means of injury: Shot gun
Signature & Address:  C. M. Aker, M.D., Lackey, Ky.
Date signed:  12 January 1948 
Transcribed by Debbie Tamborski, 18 December 2010