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DEATH
CERTIFICATE
HARVE OWENS
Date 08 July 1940
Cert: 22459
Place of Death: County: Perry City or Town:
Dwarf
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural Street No.:
No. 23
Full Name: Harve OWENS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Mary HAYS
Age of husband or wife if alive: ? [sic]
Birth date of deceased: 31 March 1855
Age: 85 years, 04 months, 09 days
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: James OWENS
Father Birthplace: North Carolina
Mother Maiden Name: Rachel COMBS
Mother Birthplace: Knott County
Informant: P. L. Johnson, Hazard, Ky.
Burial Place: Dwarf
Date: 10 July 1940
Signature of funeral director: Ray Engle, Hazard, Ky.
Date received by local registrar: 13 September 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 08 July 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: Pneumonia
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: C. B. Combs, Hazard
Date signed: 13 September 1940
Transcribed by Debbie Tamborski, 10 May 2010 |
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