Date: 10 June 1940
Cert: 15188
Place of Death: County: Knott City or Town:
May
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: May, Ky.
Full Name: Robert Lee VANCE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 14 January 1895
Age: 45 years
Birthplace: Knott
Occupation: Farmer
Industry or business: (blank)
Father Name: Osten VANCE
Father Birthplace: Knott
Mother Maiden Name: Lize PIGMAN
Mother Birthplace: Knott
Informant: Liza COLLINS, May, Ky.
Burial Place: Ivan
Date: 11 June 1940
Signature of funeral director: (blank)
Date received by local registrar: 24 June 1940
Registrar's Signature: Macie Miller
Date of Death: 10 June 1940
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: Pneumonia
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. W. Duke, M.D., Hindman
Date signed: 24 June 1940
Transcribed by Debbie Tamborski, 07 October 2010 |