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DEATH
CERTIFICATE
ADAM SLOAN
Date 07 April 1936
Cert: 11496
Place of Death: Voting Pct.: Jenkins, Letcher Co., Ky.
Full Name: Adam SLOAN
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 11 July 1912
Age: 23 years, 08 months, 27 days
Occupation: Coal Miner
Birthplace: Knott Co., Ky.
Father Name: Proctor SLOAN
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Roena COX
Birthplace Mother: Knott Co., Ky.
Informant/Address: Proctor SLOAN, Dema, Ky.
Burial Cremation Removal Place: Dema, Ky.
Date: 09 April 1936
Undertaker/Address: Geo. W. McCoy, Jenkins, Ky.
Filed: 10 May 1936
Registrar: (illegible--?egan)
Death of Date: 07 April 1936
I hereby certify, That I attended deceased from 05 April 1936 to
07 April 1936, that I last saw him alive on 07 April 1936,
death is said to have occurred on the date stated above, at
10:50 a.m.
Cause of Death: 05 April 1936 Multiple fractures of
skull. (Automobile wreck)
Date of onset: 05 April 1936
Contributory causes: (blank)
Name of operation: None
Date of: (blank)
What test confirmed diagnosis: Clinical and x-ray
Was there an autopsy: No
Accident, suicide, homicide: Accident
Date of Injury: 05 April 1936
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
On highway
Manner of injury: Automobile wreck
Nature of injury: Fractures of skull
Related to occupation: No
Signed/Address: Leon O. Spencer, M.D., Jenkins, Kentucky
Transcribed by Debbie Tamborski, 21 April 2010 |
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