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DEATH
CERTIFICATE
GEORGE M. NICKLES
Date: 20 March 1940
Cert: 17482
Place of Death: County: Knott City or Town:
Smithsboro
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Hindman
Full Name: George M. NICKLES
If Veteran Name War: (blank)
Social Security No.: 405-16-0965
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: 20 November 1901
Age: 38 years, 04 months
Birthplace: Knott
Occupation: Farmer
Industry or business: (blank)
Father Name: Maston NICKLES
Father Birthplace: Knott Co.
Mother Maiden Name: Eliza BREWER
Mother Birthplace: Perry Co.
Informant/Address: Amos NICKLES, Hindman, Ky.
Burial Place: Big Branch
Date: 22 March 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 27 July 1940
Registrar's Signature: Macie Miller
Date of Death: 20 March 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Heart failure
Duration: (blank)
Due to: Hypertrophy
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: J. W. Duke, M.D., Hindman
Date signed: 27 July 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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