Date: 05 September 1950
Cert: 18769
Place of Death: County: Knott
City or Town: Dema
Length of stay (in this place): (blank)
Street address or location: Dema, Ky.
Usual Residence of Deceased: State: Tenn.
County: Carter
City or Town: Elizabethton Street
Address: R.R. #1
Full Name: Clat Francis WILLIAMS
Date of Death: 05 September 1950
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 1904
Age: 46 years
Usual Occupation: Forman
Kind of Industry or business: Rayon Factory
Birthplace: Tenn.
Father's Name: Nat WILLIAMS
Mother's Maiden Name: Josie HENDRICK
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: Alpha WILLIAMS
Disease/condition directly leading to death: Coronary
Occlusion
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 05 September
1950 to
05 September 1950, that I last saw the deceased alive on (blank), and
that death occurred at 2:30 a.m., from the causes and on the
date stated above.
Date signed: 06 September 1950
Address: Lackey, Ky.
Signature: C. M. Aker, M.D.
Burial, Cremation or Removal: Burial
Date: 08 September 1950
Name of Cemetery or Crematory: Family
Location: Elizabethton, Tenn.
Date received by local registrar: 06 September 1950
Registrar's Signature: Mrs. Rose B. Craft
Funeral director & address: Ryan Funeral Home,
Martin, Ky.
Transcribed by Debbie Tamborski, 17 January 2011 |