Date: 08 November 1943
Cert: 15255
Place of Death: County: Knott City or
Town: Smithboro (Rural)
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Smithsboro Rural
Full Name: WM SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of: Matilda SMITH
Age of husband or wife if alive: 76 years
Birth date of deceased: 11 October 1861
Age: 82 years, 00 months, 27 days
Birthplace: Knott
Occupation: Farmer
Industry or business: (blank)
Father Name: Jerry SMITH
Father Birthplace: Knott
Mother Maiden Name: Ranie STAMPER
Mother Birthplace: Knott
Informant: Mrs. Geo. OWENS, Jr., Smithboro, Ky.
Burial Place: Smithboro, Ky.
Date: 10 November 1943
Signature of funeral director: None - Family, Smithsboro, Ky.
Date received by local registrar: 20 February 1945
Registrar's Signature: Rose B. Craft acting Per B. Carns
Date of Death: 08 November 1943
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Apoplexy
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: J. R. Aker, M.D., Anco, Ky.
Date signed: 20 February 1945
Transcribed by Debbie Tamborski, 27 October 2010
* Per JB Francis--Father should read Thomas SMITH--Mother
should read Louraina FRANCIS |