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DEATH
CERTIFICATE
MIKE WITT
Date 16 August 1941
Cert: 20835
Place of Death: County: Perry City or Town:
Hazard Hosp.
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: (blank)
Full Name: Mike WITT
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: 09 August 1941
Age: 07 days
Birthplace: Perry Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Jim WITT
Father Birthplace: Letcher Co.
Mother Maiden Name: Lida CAUDILL
Mother Birthplace: Letcher Co., Ky.
Informant: Jim WITT, Smithsboro, Ky.
Burial Place: Smithsboro
Date: 17 August 1941
Signature funeral director: Engle Und. & Hdw. Co., Hazard, Ky.
Date received by local registrar: 19 August 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 16 August 1941
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 6:30 a.m.
Immediate cause of death: Prematurity 7 mos.
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: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 18 August 1941
Transcribed by Debbie Tamborski, 02 February 2010 |
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