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DEATH
CERTIFICATE
STANLY MOORE
Date 18 January 1942
Cert: 10005
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Sassafras
Full Name: Stanly MOORE
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: 05 January 1925
Age: 16 years
Birthplace: Smithsboro, Ky.
Occupation: School Boy
Industry or business: (blank)
Father Name: Charlie MOORE
Father Birthplace: Bath, Ky.
Mother Maiden Name: Sobrina COMBS
Mother Birthplace: Smithsboro, Ky.
Informant: Charlie MOORE, Amburgey, Ky.
Burial Place: Amburgey, Ky.
Date: 20 January 1942
Signature of funeral director: None
Date received by local registrar: 26 March 1942
Registrar's Signature: Anna Laura (illegible)
Date of Death: 18 January 1942
I hereby certify that I attended deceased from 17 January 1942 to
18 January 1942, that I
last saw him alive on 18 January 1942, and that death occurred on the date
stated above at 7:35 p.m.
Immediate cause of death: Fractured skull
Due to: Shock. Compound fracture left elbow.
(illegible) fracture left side of head
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 17 January 1942
Where did injury occur: Highway
While at work: No
Means of injury: Car wreck
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 20 January 1942
Transcribed by Debbie Tamborski, 05 February 2010 |
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