|
DEATH
CERTIFICATE
VIRGINIA SMITH
Date 03 July 1940
Cert: 20197
Place of Death: County: Perry City or Town: Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Rural #20 (Lost Creek)
Full Name: Virginia SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 29 April 1929
Age: 11 years
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Andrew SMITH
Father Birthplace: Knott Co.
Mother Maiden Name: Sylva BEVERLEY
Mother Birthplace: Knott Co.
Informant: Andrew SMITH, Anco, Ky.
Burial Place: Anco
Date: 04 July 1940
Signature of funeral director: Ray Engle, Hazard, Ky.
Date received by local registrar: 20 August 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 03 July 1940
I hereby certify that I attended deceased from 03 July 1940
11:15 a.m. to 03 July 1940 11:35, that I last saw him alive on
03 July 1940, and that death occurred on the date stated above
at 11:35 a.m.
Immediate cause of death: Acute glomerul?? nephritis
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: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 26 July 1940
Transcribed by Debbie Tamborski, 02 February 2010 |
|