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DEATH
CERTIFICATE
NICK PERRY
Date 26 December 1942
Cert: 02296
Place of Death: County: Perry City or Town:
Hazard
Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Blue Diamond
Full Name: Nick PERRY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Mary PERRY
Age of husband or wife if alive: 24 years
Birth date of deceased: 06 February 1916
Age: 26 years
Birthplace: Knott Co., Ky.
Occupation: Coal Miner
Industry or business: (blank)
Father Name: Robert PERRY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Jane SLONE
Mother Birthplace: Knott County
Informant: Mary PERRY, Blue Diamond
Burial Place: Kite, Ky.
Date: 28 December 1942
Signature of funeral director: Engle Und. & Hdwe., Hazard, Ky.
Date received by local registrar: 15 January 1943
Registrar's Signature: Anna L. Boulos
Date of Death: 26 December 1942
I hereby certify that I attended deceased from 24 December
1942 to
26 December 1942, that I last saw him alive on 26 December
1942, and that death occurred on the date stated above at 1
p.m.
Immediate cause of death: Baselar fracture of skull
Duration: 03 days
Due to: Gunshot wound of neck
Major findings of operations: (blank)
Accident, suicide, or homicide: Homicide
Date of occurrence: 24 December 1942
Where did injury occur: Roadhouse
While at work: No
Means of injury: Shot with pistol
Signature & Address: Chris S. Jackson, M.D., Hazard,
Ky.
Date signed: 26 December 1942
Transcribed by Debbie Tamborski, 26 May 2010 |
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