|
DEATH
CERTIFICATE
WILLIAM SMITH
Date 09 July 1941
Cert: 19455
Place of Death: County: Floyd City or Town:
Martin
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Floyd
City or Town: Martin
Full Name: William SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Minnie
Age of husband or wife if alive: 56 years
Birth date of deceased: 04 December 1866
Age: 75 years, 07 months, 05 days
Birthplace: Knott Co., Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Bill SMITH
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Kettie OSBORNE
Mother Birthplace: Floyd Co., Ky.
Informant: Sampie SMITH, Wheelwright, Ky.
Burial Place: Martin, Ky.
Date: 11 July 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar: 21 August 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 09 July 1941
I hereby certify that I attended deceased from 01 August 1940 to
08 July 1941, that I last saw him alive on 08 July 1941, and that death
occurred on the date stated above at (blank)
Immediate cause of death: Tuberculosis of 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: W. J. Osborne, M.D., Bypro, Ky.
Date signed: 21 August 1941
Transcribed by Debbie Tamborski, 14 May 2010 |
|