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DEATH
CERTIFICATE
THOMAS SMITH JR.
Date: 12 July 1949
Cert: 15645
Place of Death: County: Clay City or Town:
Garrard
Length of stay (in this place): 62
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Kentucky County:
Clay
City or Town: Garrard Street Address: (blank)
Full Name: Thomas SMITH Jr.
Date of Death: 12 July 1949
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth: 21 February 1887
Age: 62 years
Usual Occupation: Merchant
Kind of Industry or business: Gem. Mcdse.
Birthplace: Knott Co., Ky.
Father's Name: Jeremiah SMITH
Mother's Maiden Name: Lucinda KELLY
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: (blank)
Disease or condition directly leading to death: Heart
failure
Interval between onset and death: (blank)
Due to: Hypertensive heart disease
Other significant conditions: (blank)
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 (blank) to
(blank), that I last saw the deceased alive on (blank), and
that death occurred at 1 p.m., from the causes and on the
date stated above.
Date signed: 15 August 1949
Address: Manchester, Ky.
Signature: (illegible)
Burial, Cremation or Removal: Burial
Date: 14 July 1949
Name of Cemetery or Crematory: Smith Cemetery
Location: Garrard, Ky.
Date received by local registrar: 16 August 1949
Registrar's Signature: Daisy W. Ricketts
Funeral director & address: C. Fred Rominger, Manchester,
Ky.
Transcribed by Debbie Tamborski, 13 July 2010 |
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