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DEATH
CERTIFICATE
ANCIL SLONE
Date: 10 September 1940
Cert: 10597
Place of Death: County: Knott City or Town:
rural
Name of Hospital or Institution: own home
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Rural If rural give
precinct: Upper Jones Fork
Full Name: Ancil SLONE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 26 August 1940
Age: 17 days
Birthplace: Mousie, Ky., Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Clinon SLONE
Father Birthplace: Pippapass, Ky., Knott Co.
Mother Maiden Name: Lula SLONE
Mother Birthplace: Pippapass, Ky., Knott Co.
Informant/Address: Clinon SLONE, Mousie, Ky.
Burial Place: Mousie, Ky.
Date: 11 September 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 28 April 1941
Registrar's Signature: Macie Miller
Date of Death: 10 September 1940
I hereby certify that I attended deceased from 25 August 1940 to
26 August 1940, that I last saw him alive on 27 August 1940,
and that death occurred on the date stated above at 3 a.m.
Immediate cause of death: Diarrhoea [sic]
Duration: 15 days
Due to: (blank)
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: Mark Dempsey, Hindman, Ky.
Date signed: 11 September 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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