Date: 06 April 1943
Cert: 15283
Place of Death: County: Knott City or
Town: Red Fox
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: Red Fox
Full Name: John Riley WILLIAMS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, Black, Widowed
Husband or Wife of: Viney WILLIAMS
Age of husband or wife if alive: (blank)
Birth date of deceased: unknown
Age: 81 years
Birthplace: Red Fox, Kentucky
Occupation: Day Laborer
Industry or business: (blank)
Father Name: Phoeba WILLIAMS
Father Birthplace: Kentucky
Mother Maiden Name: Henry WILLIAMS
Mother Birthplace: Kentucky
Informant: Wesley BREEDING, Red Fox, Kentucky
Burial Place: Breedings Creek
Date: 08 April 1943
Signature of funeral director: Friends, Red Fox
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 06 April 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: Influenza
Duration: (blank)
Due to: Old Age
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: 16 March 1945
Transcribed by Debbie Tamborski, 29 October 2010 |