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DEATH
CERTIFICATE
GROVER CLEVELAND
SEXTON
Date 12 December 1940
Cert: 02451
Place of Death: County: Letcher City or Town:
Fleming
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Letcher
City or Town: Rural Street No.:
Farraday, Ky.
Full Name: Grover Cleveland SEXTON
If Veteran Name War: (blank)
Social Security No.: 403-10-3641
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Nancy Jane SEXTON
Age of husband or wife if alive: 50 years
Birth date of deceased: 28 April 1887
Age: 53 years, 07 months, 14 days
Birthplace: Pine Top, Knott Co., Ky.
Occupation: Coal Miner
Industry or business: coal mines
Father Name: not given
Father Birthplace: ? [sic]
Mother Maiden Name: not given
Mother Birthplace: ? [sic]
Informant: Sam Cox (clerk of store), Farraday, Ky.
Burial Place: Bastin, Ky.
Date: 14 December 1940
Signature funeral director: Burke Funeral Home, Whitesburg,
Ky.
Date received by local registrar: 27 January 1941
Registrar's Signature: E. M. Collins
Date of Death: 12 December 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 6 a.m.
Immediate cause of death: Shock due to crushing mine
injury - by motor car and coal; lived only a few hrs.
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 11 December 1940
Where did injury occur: Industry
While at work: Yes
Means of injury: Motor car & coal
Signature & Address: R. D. Collins, M.D.,
Whitesburg, Ky.
Date signed: 26 January 1941
Transcribed by Debbie Tamborski, 10 May 2010 |
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