Date:   29 November 1943
Cert:   15303 
Place of Death: County: Knott     City or Town: De Coy
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  De Coy
Full Name:  Birley SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Child
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 10 years
Birthplace:  (blank)
Occupation: (blank)
Industry or business: (blank)
Father Name: (blank)
Father Birthplace: (blank)
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: (at bottom of page is written Informants Chester SMITH Wm. SMITH, De Coy, Ky.)
Burial Place: (blank)
Date:   (blank)
Signature of funeral director: (blank)
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 29 November 1943
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: (blank)
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: (blank)
Date signed:  (blank)
Transcribed by Debbie Tamborski, 27 October 2010