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DEATH
CERTIFICATE
JOHN W. SLONE
Date: 23 December 1940
Cert: 02306
Place of Death: County: Knott Co. City or Town:
Dema
Name of Hospital or Institution: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Dema Street No.:
Rural
Full Name: John W. SLONE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 26 January 1859
Age: 81 years, 11 months, 27 days
Birthplace: Floyd Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Spencer SLONE
Father Birthplace: Floyd Co.
Mother Maiden Name: Emly MCKINEY
Mother Birthplace: Floyd Co.
Informant/Address: B. M. SLONE, Dema
Burial Place: Dema
Date: 24 December 1940
Signature of funeral director/address: W. J. Ryan, Martin, Ky.
Date received by local registrar: 23 January 1941
Registrar's Signature: Macie Miller
Date of Death: 23 December 1940
I hereby certify that I attended deceased from 21 December
1940 to
23 December 1940, that I last saw him alive on 23 December
1940, and that death occurred on the date stated above at 8:00
a.m.
Immediate cause of death: Acute Dilatation Heart
Duration: (blank)
Due to: Cardio Renal Disease
Other Conditions: Senility
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: A. B. Pigman, M.D., Wayland
Date signed: 25 December 1940
Transcribed by Debbie Tamborski, 29 August 2010 |
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