Date: 12 May 1945
Cert: 13010
Place of Death: County: Knott City or
Town: Hindman Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Hindman Street No.:
Rural
Full Name: Charles Henry NICKLES
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: 10 May 1945
Age: 02 days
Birthplace: Hindman, Ky.
Rural
Occupation: None
Industry or business: (blank)
Father Name: Ishmael NICKLES
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Lizzie SMITH
Mother Birthplace: Knott Co., Ky.
Informant: Lizzie NICKLES, Hindman, Ky.
Burial Place: Hindman Rural
Date: 13 May 1945
Signature of funeral director: None
Date received by local registrar: 01 June 1945
Registrar's Signature: Rose B. Craft
Date of Death: 12 May 1945
I hereby certify that I attended deceased from 10 May 1945 to
12 May 1945, that I last saw him alive on 12 May 1945, and that death
occurred on the date stated above at (blank)
Immediate cause of death: pneumonia
Duration: 02 days
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: R. E. Cumming, (illegible),
Combs, Ky.
Date signed: (illegible)
Transcribed by Debbie Tamborski, 29 November 2010 |