Death certificate

Partial Transcript

West Virginia State Department of Health

Division of Vital Statistics

 

  1. Place of Death:
    1. County: Kanawha
    2. Magisterial District: Charleston Independent
    3. City or town: Charleston
    4. Address: Charleston Gen. Hospital
    5. Length of stay in hospital or inst: 4 days
  2. Home (Usual Residence)of Deceased:
    1. State: W. Va.
    2. County: Kanawha
    3. City or town: Cedar Grove
    1. Full Name: Gilbert Durie
  4. Sex: Male
  5. Color or race: White
    1. Single, married, widowed, or divorced: [blank]
    2. Name of husband or wife: [struck out]
  7. Birth date of deceased: Oct. 10, 1927
  8. Age: 18 years
  9. Birthplace: Reed, WVa.
  10. Usual occupation: [blank]
  11. Industry or business: [blank]
  12. Father’s name: Gilbert Durie
  13. Father’s birthplace: Scotland
  14. Mother’s name: Ruth Marshall
  15. Mother’s birthplace: Reed, WVa.
    1. Informant’s signature: [signature]
    2. Address: Cedar Grove, WVa.
    1. Burial, cremation, or removal: Buried
    2. Date thereof: 4-17-46
    3. Cemetery or crematory: Spring Hill, Charleston WVa
    1. Funeral director: [signature]
    2. Address: Belle, WVa.
  19. Filed: 4-27 1946, Bessie Humphries, Registrar

 

MEDICAL CERTIFICATION

  1. Date of death: April 14, 1946 at 10:35 PM
  2. I certify that death occurred on the date above stated, etc.
  • Immediate cause of death: Cerebral contusion; traumatic amputation left foot; fracture rt. femur; multiple lacerations scalp.
  • Major findings of autopsy: Basal skull fracture.
  1. If external causes contributed to the death fill in the following:
    1. Accident, suicide, or homicide: accident
    2. Date of occurrence: April 10, 1946
    3. Where did injury occur? Struck by train near Cedar Grove, W. Va
    4. Did injury occur about home, on farm, industrial place, in public place? Struck by train.
    5. Means of injury: Struck by train.
  2. Signature: George Miyakawa, M.D., Cedar Grove, W. Va.