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DEATH
CERTIFICATE
HILLIARD SMITH
Date 17 March 1934
Cert: 31121
Place of Death: Voting Pct.: Vicco, Perry Co., Ky.
Full Name: Hilliard SMITH
Residence: (blank)
Length of Residence where death occurred: 01 years, 06 months,
03 days
Sex, Color or Race, Marital Status: White, Widowed
Husband or Wife of: Millie SMITH
Date of Birth: 18 March 1859
Age: 76 years, 08 months, 14 days
Occupation: (blank)
Birthplace: Knott Co., Ky.
Father Name: Hilliard SMITH
Birthplace Father: (blank)
Mother Maiden Name: (blank)
Birthplace Mother: (blank)
Informant/Address: (blank), Vicco, Ky.
Burial Cremation Removal Place: (illegible) Smith
Date: 18 March 1934
Undertaker/Address: (blank), Vicco, Ky.
Filed: 01 December 1936
Registrar: C. D. Combs
Death of Date: 17 March 1934
I hereby certify, That I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), death is said
to have occurred on the date stated above, at (blank)
Cause of Death: He died (illegible) his
(illegible) (??yellow jaundis??)
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: His (illegible)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: Vina B. Smith, M.D., Vicco, Ky.
Transcribed by Debbie Tamborski, 16 April 2010 |
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