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DEATH
CERTIFICATE
HENRY SMITH
Date 19 October 1921
Cert: 29007 Corrected Copy
Place of Death: Voting Precinct: Lotts Cr., Perry Co,
Ky.
Full Name: Henry SMITH
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 23 August 1889
Age: 32 years, 02 months
Occupation: Farmer
Birthplace: Knott Co., Ky.
Name of Father: A. J. SMITH
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Nancy SPARKMAN
Birthplace Mother: Knott Co., Ky.
Informant/Address: Jno. M. SMITH, Hardburly, Ky.
Filed: 15 November 1923
Registrar: J. P. Boggs
Death Date: 19 October 1921
I hereby certify that I attended deceased from May 1920, to
19 October 1921, that I last saw him alive on 18 October 1921,
and that death occurred, on the date stated above, at 9 a.m.
Cause of Death: Hodgkin's Disease
Duration: 01 year, 05 months
Contributory: (blank)
Signed/Address: H. W. Gingles, MD, 15 November
1923, Hardburly, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Hazard Hdw. Co.
Date of Burial: 21 October 1921
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 07 March 2010 |
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