Date:  20 March 1949
Cert:  16790 
Place of Death: County: Knott   City or Town: Mousie, Ky. Rural
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Kentucky   County: Knott
City or Town: Mousie   Rural     Street Address: (blank)
Full Name:  Homer SMITH
Date of Death:  20 March 1949
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth:  21 May 1928
Age:  20 years, 09 months, 29 days
Usual Occupation:  Work in Rubber Plant
Kind of Industry or business: (blank)
Birthplace:  Kentucky
Father's Name:  Adam SMITH
Mother's Maiden Name:  Betty WICKER
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  M. D. SMITH
Disease or condition directly leading to death: Gun shot wound
Interval between onset and death:  (blank)
Due to:  (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: Suicide
Place of injury: Home
City or Town, County, State:  Mousie, Knott, Ky.
Time of Injury:  20 March 1949, 7 p.m.
Injury occurred at work: Not while at work
How did injury occur: Man place 22 rifle against door facing & shot himself through the heart
I hereby certify that I attended deceased from (blank) to (blank), that I last saw the deceased alive on (blank), and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  31 August 1949
Address:  Hindman, Ky.
Signature:  J. W. Duke, M.D.
Burial, Cremation or Removal:  Burial
Date:  22 March 1949
Name of Cemetery or Crematory:  Mousie Cemetery
Location:  Mousie, Knott, Ky.
Date received by local registrar: 31 August 1949
Registrar's Signature:  Rose B. Craft
Funeral director & address:  Friends, Mousie, Ky.
Transcribed by Debbie Tamborski, 08 January 2011