Date:  04 October 1955
Cert:  #20889
Place of Death: County: Knott      City or Town: Rural
Length of stay (in this place): all of life
Street address or location:  Mousie, Ky.
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Rural    Street Address: Mousie, Ky.
Full Name:  Bonom SMITH
Date of Death:  04 October 1955
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth:  07 June 1913
Age: 42 years
Usual Occupation: Farmer
Kind of Industry or business: Farming
Birthplace:  Knott Co., Ky.
Father's Name:  Richard SMITH
Mother's Maiden Name:  Margaret SMITH
Was deceased ever in armed forces: (blank)
Social Security No.: 407-07-9930
Informant:  Denny SMITH
Disease or condition directly leading to death:  Arterioslerotic Heart Disease
Interval between onset and death:  (blank)
Due to:  (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 01 June 1953 to 04 October 1955, that I last saw the deceased alive on 04 October 1955, and that death occurred at 11:30 p.m., from the causes and on the date stated above.
Date signed:  07 October 1955
Address:  Garrett, Ky.
Signature:  Dr. Mark Dempsey
Burial, Cremation or Removal: Burial
Date:  07 October 1955
Name of Cemetery or Crematory: Family Cemetery
Location:  Mousie, Ky.
Date received by local registrar:  13 October 1955
Registrar's Signature: Myrtle Slone
Funeral director & address:  John N. Taul, Mt. Sterling, Ky., Eastin Richey Funeral Home
Transcribed by Debbie Tamborski, 08 June 2011