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DEATH
CERTIFICATE
HILLARD HAGAN SMITH, JR.
Date 31 October 1930
Cert: 24408
Place of Death: Voting Pct: Good Sam. Hosp., Lexington,
Fayette Co., Ky.
Full Name: Hillard Hagan SMITH, Jr.
Residence: Hindman, Ky.
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 27 December 1905
Age: 25 years, 10 months, 03 days
Occupation: (blank)
Birthplace: Knott Co., Ky.
Father Name: H. Hagan SMITH
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Dicie FRANCIS
Birthplace Mother: Knott Co., Ky.
Informant/Address: H. H. SMITH, Hindman, Ky.
Filed: 05 November 1930
Registrar: D. A. Furlong
Death of Date: 31 October 1930
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), and that death
occurred on the date stated above at 5:15 p.m.
Cause of Death: Fractured skull and internal injuries
sustained in an accidental Auto Accident
Duration: (blank)
Contributory: Auto Accident 8 miles
Winchester Rd. (Fayette Co.)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: J. H. Kerr, Coroner, 03 November 1930,
Lexington, Ky.
Place of Burial or Removal: Hindman, Ky.
Date of Burial: 02 November 1930
Undertaker/Address: Kerr Bros., Lex., Ky.
Transcribed by Debbie Tamborski, 29 March 2010 |
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