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DEATH
CERTIFICATE
A. W. SHEPHERD
Date 30 June 1940
Cert: 15290
Place of Death: County: Lewis Co. City or Town:
Quincy
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Lewis
City or Town: Vanceburg
Full Name: A. W. SHEPHERD
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Nancy SHEPHERD
Age of husband or wife if alive: 76 years
Birth date of deceased: 06 November 1862
Age: 78 years, 09 months
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Brice SHEPHERD
Father Birthplace: Knott Co.
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: Polly CLEMONS, Quincy, Ky.
Burial Place: Sand Gap
Date: 02 July 1940
Signature of funeral director: Plommer Bros., Vanceburg,
Ky.
Date received by local registrar: 01 July 1940
Registrar's Signature: Mrs. P. G. Rice
Date of Death: 30 June 1940
I hereby certify that I attended deceased from 12 June 1940 to
27 June 1940, that I last saw him alive on 27 June 1940, and
that death occurred on the date stated above at 7 p.m.
Immediate cause of death: Cancer of Prostrate Gland
Duration: (blank)
Due to: Chronic Cystitis
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: T. B. Ginn, M.D., Vanceburg, Ky.
Date signed: 01 July 1940
Transcribed by Debbie Tamborski, 10 May 2010 |
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