Date: 27 January 1950
Cert: 03214
Place of Death: County: Knott
City or Town: Rural
Length of stay (in this place): All of life
Street address or location: Leburn, Ky.
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural If rural give
precinct: Leburn, Ky.
Full Name: Robert Warren SMITH
Date of Death: 27 January 1950
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth: 27 February 1943
Age: 06 years
Usual Occupation: None
Kind of Industry or business: None
Birthplace: Knott Co., Ky.
Father's Name: John SMITH
Mother's Maiden Name: Eva COMBS
Was deceased ever in armed forces: (blank)
Social Security No.: None
Informant: John SMITH
Disease or condition directly leading to death: Hodgkins
Disease
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: (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 15 January 1950 to
27 January 1950, that I last saw the deceased alive on 27
January 1950, and
that death occurred at 9:00 a.m., from the causes and on the
date stated above.
Date signed: 02 February 1950
Address: Hindman, Ky.
Signature: M. F. Kelley
Burial, Cremation or Removal: Burial
Date: 29 January 1950
Name of Cemetery or Crematory: Watts
Location: Garner, Ky.
Date received by local registrar: 07 January 1950 (transcribed
as written)
Registrar's Signature: Rose B. Craft
Funeral director/address: Hindman Funeral Home, Hindman, Ky.
Transcribed by Debbie Tamborski, 17 January 2011 |