|
DEATH
CERTIFICATE
HAGIE SMITH
Date 13 December 1942
Cert: 02287
Place of Death: County: Perry City or Town:
Hazard
Street No. or Location: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural If rural give precinct: (?Darbfork?
illegible)
Full Name: Hagie SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 51 years
Birthplace: Knott Co., Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: James SMITH
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Elizabeth JOHNSON
Mother Birthplace: Knott Co., Ky.
Informant: (?Daily? illegible), (?Darbfork? illegible)
Burial Place: (?Toley? Cr. illegible)
Date: 15 December 1942
Signature of funeral director: Engle Und. &
Hdwe. Co., Hazard, Ky.
Date received by local registrar: 01 January 1943
Registrar's Signature: A. L. Boulos
Date of Death: 13 December 1942
I hereby certify that I attended deceased from 12 December
1942 to 13 December 1942, that I last saw him alive on 13
December 1942, and that death occurred on the date stated
above at 2:40 p.m.
Immediate cause of death: Gunshot wound (38 cal) of abdomen,
(illegible), bladder
Duration: (blank)
Other conditions: Gunshot at (illegible)
Major findings of operations: 8 perforations in small bowel,
one in abdomen
Accident, suicide, or homicide: Homicide
Date of occurrence: 12 December 1942
Where did injury occur: Public Highway @ Deane, Ky.
While at work: no
Means of injury: gunshot
Signature & Address: Chris S. Jackson, M.D., Hazard,
Ky.
Date signed: 19 December 1942
Transcribed by Debbie Tamborski, 30 May 2010 |
|