|
DEATH
CERTIFICATE
RICHARD MORTON
Date: 02 July 1940
Cert: 19751
Place of Death: County: Knott City or Town:
Cody
Name of Hospital or Institution: Home
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Cody
Full Name: Richard MORTON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Mary MORTON
Age of husband or wife if alive: (blank)
Birth date of deceased: 17 April 1866
Age: 74 years, 02 months, 28 days
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Henry MORTON
Father Birthplace: Tennessee
Mother Maiden Name: Polly GIBSON
Mother Birthplace: Knott Co.
Informant/Address: Mary MORTON, Cody, Ky.
Burial Place: Stamper graveyard
Date: 03 July 1940
Signature of funeral director/address: Sam Stamper, Litt Carr
Date received by local registrar: 20 August 1940
Registrar's Signature: Macie Miller
Date of Death: 02 July 1940
I hereby certify that I attended deceased from 02 July 1940 to
02 July 1940, that I last saw him alive on 02 July 1940, and that death
occurred on the date stated above at (illegible)
Immediate cause of death: Cancer of Stomach Tuberculosis
Duration: (blank)
Due to: (blank)
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 & Address: Guy C. Pinckley, Anco, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 28 August 2010 |
|