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DEATH
CERTIFICATE
(NOT NAMED) SLONE
Date: 21 March 1940
Cert: 10412
Place of Death: County: Knott City or Town:
Lackey
Name of Hospital or Institution: Stumbo Mem. Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: (blank) County:
(blank)
City or Town: (blank)
Full Name: (not named) SLONE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: White
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 20 March 1940
Age: 01 days
Birthplace: Knott
Occupation: Miner
Industry or business: (blank)
Father Name: Juda SLONE
Father Birthplace: Knott
Mother Maiden Name: Lucy MOSLEY
Mother Birthplace: Knott - Leburn
Informant/Address: (blank)
Burial Place: (blank)
Date: (blank)
Signature of funeral director/address: (blank)
Date received by local registrar: 26 March 1940
Registrar's Signature: Macie Miller
Date of Death: 21 March 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 (blank)
Immediate cause of death: Premature birth
Duration: (blank)
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: C. B. Ison, M.D., Lackey
Date signed: 21 March 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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