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DEATH
CERTIFICATE
JESSE B. SMITH
Date: 25 September 1950
Cert: 20135
Place of Death: County: Floyd City or Town:
ByPro
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: ByPro Street
Address: none
Full Name: Jesse B. SMITH
Date of Death: 25 September 1950
Sex, Color or Race, Marital Status: Male, White, Widowed
Date of Birth: 13 March 1874
Age: 76 years, 06 months, 14 days
Usual Occupation: Farmer
Kind of Industry or business: Farming
Birthplace: Pine Top, Ky.
Father's Name: William B. SMITH
Mother's Maiden Name: Darcus AMBURGEY
Was deceased ever in armed forces: no
Social Security No.: none
Informant: Jesse B. SMITH, Jr.
Disease or condition directly leading to death: Myocarditis
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: Asthma
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
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 01 January 1950 to
25 September 1950, that I last saw the deceased alive on 25
September 1950, and
that death occurred at 11:55 p.m., from the causes and on the
date stated above.
Date signed: 02 October 1950
Address: ByPro, Ky.
Signature: W. D. Osborne, M.D.
Burial, Cremation or Removal: Burial
Date: 30 September 1950
Name of Cemetery or Crematory: Family Cemetery
Location: Hindman, Ky.
Date received by local registrar: 04 October 1950
Registrar's Signature: Lucy Ransdell
Funeral director/address: Omar Paul Greene, 2723 ByPro, Ky.
Transcribed by Debbie Tamborski, 21 July 2010 |
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