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DEATH
CERTIFICATE
ADAM SMITH
Date: 21 November 1947
Cert: 23964
Place of Death: County: Floyd City or Town: Langley
Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: Eastern
Full Name: Adam SMITH
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: 30 January 1924
Age: 23 years
Birthplace: Knott Co., Ky.
Occupation: Miner (coal)
Industry or business: (blank)
Father Name: Elias SMITH
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Elizabeth SHEPHERD
Mother Birthplace: Knott Co., Ky.
Informant: Kelley SMITH, Eastern, Ky.
Burial Place: Hindman, Ky.
Date: 24 November 1947
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 26 November 1947
Registrar's Signature: Lucy Ransdell
Date of Death: 21 November 1947
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 9 a.m.
Immediate cause of death: Brain Injury
Duration: (blank)
Due to: Skull Fracture
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 21 November 1947
Where did injury occur: Inside coal mine
While at work: Yes
Means of injury: Slate fall
Signature & Address: W. J. Ryan, Embalmer, Martin,
Ky.
Date signed: 23 November 1947
Transcribed by Debbie Tamborski, 25 June 2010 |
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