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DEATH
CERTIFICATE
HAZEL RICHIE
Date: 25 December 1943
Cert: 28267
Place of Death: County: Perry Co. City or Town:
Rural
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Perry
City or Town: Rural
Full Name: Hazel RICHIE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 13 November 1926
Age: 17 years, 01 months, 12 days
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Joe RICHIE
Father Birthplace: Knott Co.
Mother Maiden Name: Irene FUGATE
Mother Birthplace: Knott Co.
Informant: (illegible), Hazard, Ky.
Burial Place: Talcom
Date: 28 December 1943
Signature funeral director: Maggard Funeral Home, Hazard, Ky.
Date received by local registrar: 30 December 1943
Registrar's Signature: Anna L. Boulos
Date of Death: 25 December 1943
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: Skull fracture
Duration: (blank)
Due to: automobile accident
Major findings of operations: (blank)
Accident, suicide, or homicide: accident
Date of occurrence: 25 December 1943
Where did injury occur: Highway
While at work: no
Means of injury: (blank)
Signature & Address: Ed H. Ivey, Coroner, P.C. Co.,
Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 02 June 2010 |
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