Date:    14 November 1944
Cert:    27652 
Place of Death: County: Knott   City or Town:  Hindman, Ky.
Street Number or Location:  Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County:  Knott
City or Town:  Hindman     Street No.:  Rural 
Full Name:  John SMITH 
If Veteran Name War: None
Social Security No.: (blank)
Sex, Color or Race, Marital Status:  Male, White, Widowed
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:   05 April 1858
Age:  86 years, 07 months, 11 days
Birthplace:  Knott Co., Ky. 
Occupation:   Farmer 
Industry or business: (blank)
Father Name:  Bill SMITH 
Father Birthplace:  Knott Co., Ky. 
Mother Maiden Name:   (blank)
Mother Birthplace:  (blank) 
Informant:  (blank) 
Burial Place: Nickles Cemetery
Date:   16 November 1944
Signature of funeral director:  Sam Smith, Kite, Ky.
Date received by local registrar:  30 December 1944 
Registrar's Signature: Ida Livingston Rose B. Craft Acting Registrar
Date of Death:  14 November 1944
I hereby certify that I attended deceased from 01 November 1944 to 14 November 1944, that I last saw him alive on 01 November 1944, and that death occurred on the date stated above at 5 a.m.
Immediate cause of death:  Tuberculosis of the lungs
Duration: (blank)
Due to:  (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work:  (blank)
Means of injury: (blank)
Signature & Address:  M. F. Kelley, M.D., Hindman, Ky.
Date signed:  23 November 1944 
Transcribed by Debbie Tamborski, 22 November 2010