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DEATH
CERTIFICATE
HENRY SMITH
Date: 14 November 1952
Cert: 22644
Place of Death: County: Boyd City or Town:
Ashland
Length of stay (in this place): (blank)
Street Address or Location: R. F. D. 1
Usual Residence of Deceased: State: Ky. County:
Boyd
City or Town: Ashland Street
Address: R. F. D. 1
Full Name: Henry SMITH
Date of Death: 14 November 1952
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 01 May 1865
Age: 87 years
Usual Occupation: Retired
Kind of Industry or business: Farmer
Birthplace: Knott Co.
Father's Name: Ben SMITH
Mother's Maiden Name: ____ OLIVER
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Luther BARKER
Disease/condition directly leading to death: Cerebral
Hemorrhage
Interval between onset and death: 03 weeks according to
History
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 (blank) to
(blank), that I last saw the deceased dead on 14 November 1952, and
that death occurred at 8:15 a.m., from the causes and on the
date stated above.
Date signed: 14 November 1952
Address: Ashland, Ky.
Signature: J. Fred Miller, Coroner of Boyd Co.
Burial, Cremation or Removal: Burial
Date: 16 November 1952
Name of Cemetery or Crematory: Family
Location: Elliot Co., Ky.
Date received by local registrar: 14 November 1952
Registrar's Signature: Mrs. C. P. Garen
Funeral director & address: J. Fred Miller, Ashland,
Ky.
Transcribed by Debbie Tamborski, 12 August 2010 |
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