Date: 20 July 1945
Cert: 15268
Place of Death: County: Knott City or
Town: Rural Decoy, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Decoy Rural
Full Name: Chester SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White,
Married
Husband or Wife of: Tennie SMITH
Age of husband or wife if alive: 34 years
Birth date of deceased: 13 June (blank)
Age: 35 years, 01 months, 07 days
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Wise SMITH
Father Birthplace: Kentucky
Mother Maiden Name: Teely SHEPHARD
Mother Birthplace: Kentucky
Informant: Sam BRADLEY, Decoy, Ky.
Burial Place: Decoy, Ky.
Date: 21 July 1945
Signature of funeral director: None Supplies - Ray &
Blake, Jackson, Ky.
Date received by local registrar: 24 July 1945
Registrar's Signature: Rose B. Craft
Date of Death: 20 July 1945
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 12 N
Immediate cause of death: Drowned
Duration: (blank)
Due to: Epileptic fit
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: J. W. Duke, M.D., Hindman
Date signed: 23 July 1945
Transcribed by Debbie Tamborski, 30 November 2010 |