|
DEATH
CERTIFICATE
RICHARD SLONE
Date: 04 August 1940
Cert: 21958
Place of Death: Voting Pct. Topmost, Knott Co., Ky.
Full Name: Richard SLONE
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: Baby
Date of Birth: 04 August 1940
Age: 06 hours, 35 minutes
Occupation: (blank)
Birthplace: (blank)
Father Name: Herbert SLONE
Birthplace Father: Topmost, Ky.
Mother Maiden Name: Sella CRAFT
Birthplace Mother: Floyd Co., Ky.
Informant/Address: Herbert SLONE, Topmost, Ky.
Burial Cremation Removal Place: Topmost, Ky.
Date: 05 August 1940
Undertaker/Address: Family
Filed: 17 September 1940
Registrar: Macie Miller
Death of Date: 04 August 1940
I hereby certify, That I attended deceased from 04 August 1940
to 04 August 1940, that I last saw him alive on 04 August
1940, death is said to have occurred on the date stated above,
at 3:20 p.m.
Cause of Death: Congenital Heart Disease
Date of onset: (blank)
Contributory causes: Premature
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: A. B. Pigman, M.D., Wayland
Transcribed by Debbie Tamborski, 06 October 2010 |
|