Date:   21 March 1941
Cert:   10608 
Place of Death: County: Knott Co. City or Town: Pine Top, Ky.
Name of Hospital or Institution: none
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.    County: Knott Co.
City or Town:  Rural
Full Name:  Shelby TAYLOR
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  21 March 1941
Age: 30 minutes
Birthplace:  Pine Top, Knott Co.
Occupation:  (blank)
Industry or business: (blank)
Father Name:  Amos TAYLOR
Father Birthplace:  Knott Co.
Mother Maiden Name:  Myrtle SLONE
Mother Birthplace:  Knott Co.
Informant:  Amos TAYLOR, Pinetop, Ky.
Burial Place:  Mary Bell Pigman Semitary on Troublesome
Date:  21 March 1941
Signature of funeral director: (blank)
Date received by local registrar:  08 April 1941
Registrar's Signature:  Macie Miller
Date of Death:  21 March 1941
I hereby certify that I attended deceased from 20 March 1941 to 21 March 1941, that I last saw h-- alive on 21 March 1941, and that death occurred on the date stated above at 6 p.m.
Immediate cause of death:  Crippled Deformed
Duration: (blank)
Due to: (blank)
Other conditions:  8 months child
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Eliza Short, Mid, Mallie, Ky.
Date signed:  31 March 1941
Transcribed by Debbie Tamborski, 15 October 2010