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DEATH
CERTIFICATE
HARLAND PENNINGTON
Date: 29 June 1940
Cert: 17480
Place of Death: County: Knott City or Town:
Hollybush
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: Hollybush
Full Name: Harland PENNINGTON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Minnie Belle PENNINGTON
Age of husband or wife if alive: 17 years
Birth date of deceased: 04 June 1918
Age: 22 years
Birthplace: Grayson Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: John Franklin PENNINGTON
Father Birthplace: Grayson Co.
Mother Maiden Name: Elizabeth SARGENT
Mother Birthplace: Ohio
Informant/Address: Ada CAUDILL, Hollybush
Burial Place: Hollybush
Date: 30 June 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 09 July 1940
Registrar's Signature: Macie Miller
Date of Death: 29 June 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: (blank)
Duration: (blank)
Due to: Gun shot wounds
Major findings of operations: (blank)
Accident, suicide, or homicide: accident
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, Ky.
Date signed: 09 July 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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