xt7kh12v6014_440 https://exploreuk.uky.edu/dips/xt7kh12v6014/data/mets.xml https://exploreuk.uky.edu/dips/xt7kh12v6014/data/2008ms006.dao.xml Benham Coal Mines. (Benham, Ky.) 151.0 Cubic feet 302 Boxes The Benham Coal Company records (151 cubic feet, 302 Boxes; dated 1911-1973) focus primarily on the early years of Benham Coal through the 1940s, including office files, Employee Benefits Association records, files on accidents and safety, and photographs. archival material English University of Kentucky This digital resource may be freely searched and displayed.  Permission must be received for subsequent distribution in print or electronically.  Physical rights are retained by the owning repository.  Copyright is retained in accordance with U. S. copyright laws.  For information about permissions to reproduce or publish, contact the Special Collections Research Center. Benham Coal Company Records African American coal miners--Kentucky--Harlan County Coal miners--Kentucky--Harlan County Coal mines and mining--Appalachian Region Coal mines and mining--Appalachian Region--History. Coal mines and mining--Kentucky--Benham--History Company towns--Kentucky--Benham Monthly text Monthly 2015 https://exploreuk.uky.edu/dips/xt7kh12v6014/data/2008ms006/2008ms006_37/2008ms006_37_4/41811/41811.pdf 1939 1939 1939 section false xt7kh12v6014_440 xt7kh12v6014 Jaycee ;r· 9
REPORT OF N()N.FA"[`A|__ ACCIDENTS DURING THE, MONTH OF ...............A........................ X ............................ , 193 ............
·— 2: E —=
Form I'}-100 ,; E       E Y ,
NAME 2 Q ¤   9 Q, i. NATURE OF INJURY
2 gg é     2 2
aj ____ cz 1; Q ay c.; .:3
cn ‘* 2 c > M E-
MINE OPERATORS’ C "’ “ °
B     B. H. Love 1-30 Ifzvrried Iwwricnn Coal Inside 5 wks. 'Frectiires first end second znetatarsals right foot.
loader
Also Fatal Accident Report
TO
STATE DEPARTMENT OF MINES AND
MINERALS,
LEXINGTON
Month of ....; E.; ............. JY. ..................................... , 193..:/ ....
"```"``'"``"````"`”```` &§}L}¥{.§`QE`"&j§&}§`g¥"i$¥"62§ii&}$;L}§§j `````'"`"`````````````'
.,_.I..,.....»...V...,`...._.............I I   ................ Q .....................................
(Name or N0. of Mine)
`"`"``'``````>`````"``"‘OOA"`""```'``'` EiIéE§i`é1i"§tE$ ````"``'`'```````''``-````""````````"```
County of .....   .r........   ..,.............................................. L
This report. must be forwarded promptly at end
of ouch month to the Department of Mines and
l\Iii1t>r1ils, Lexington.
All persons refusing to furnish these reports to
the State Department of Mines and Minerals as set
out in Sov. l2 and 13 Kentucky Mining Law is sub-
ject; to :1. Fine of not less than $25.00 nor more than
$200.00.
JOHN F. DANIEL, Chief,
Department of Mines and Minerals.
It Name of Company Changed During the Month Give Former Name anti Date Changed:

 I·‘··iiii LLIUU Revised
THIS IS TI-IE PROPERTY OF THE STATE OF KENTUCKY AND MUST NOT BE DESTI. D
. J R
MINE ()PFRATORS’ MONTHLY REPO A T
A ` n ` A °
1:,0 1* atal ccndcnt Report
IO T HE EH AI I; DEPARIMENT OF MIN LS AND MINLRALS, LEXING I` ON, KY.
lwlonthly report must be filled out complete each month and returned to thc State Department of II/lines and Minerals. In the event
themincis110tW0rl;<   z ?~— .£:=¤ EE. Ka ZE
llmnth L E E L3 L-· Q T. ua   i $.3 O E 2 La M Ti
c `“ Em O E 5 G O 2, " S 5 z ¢ m ¢ se
· :/2 »r U » O ~v· I ;.. ,`, Cam v E ;_.,`Z'. "
Qs *.2   iw   ze 5,:%   26 ’Q<
‘       Ore EE   IEE ?¤   EE
E; Eg   -,:3 E; _:?: >cSL1.*Z¢ Eg   5*5
ZM Pm 71;-a <.£2 F; KO ACO irrr /Z·‘Z Zhi
` R   · Y T 4 V r- K 1 if ,· Ll;
]{rTpm·(_ ull fulul grgl-ilhguig; in {iimw; lyluuk spiiicw Sl*·ll"‘l ·-·——»—-—-rr···rr·-------·· · *-····’’r · ··’·~··r-—rr Y *~*·r··rr - ----·----~··---··~·······-~····---·
uml mnil iimur:IinIc·l5‘ I0 lim I.<=>:i1ir;Im1 Of1`iCr>.
'1`lllv V.».. . ......rr,rIrr».r.r.rII..........t.V...................... . ..... , .............
All milrfulail a1<·<·ii'l blank and smut in al lim Mid ¤" ah mrmlh rzlimg
xxiih nlhpr ihfiwmafimi l`•"(]IlV**lV·ll rm llilu

 1:*
REPORT OF N()N-FATA]__ AC(jll)E',N'l S DURING THE MONTH OF .......... .-...‘?Y?.¥T¥%.=‘%I.Y ...................A.........,......... , l93..? ........
;,, PI 2 4.:
Q jj O '___ U2
p, . L ·—• ‘** ·¤ —- O
1s""* ’ m" NAME g g E Q, §§2 A NATURE OF INJURY
G. s2 .2 z s   2 ¤»
tg Q5 él ·:   ¤ SF ig, E
T M T OJ ’> J O  
MENE OPERATORS Q "" " “ ’ `
MONTHLY REPORT Nwtoz
,3JsO Fam: Acrident Report No lo st—-time er  —t_;('; [V ·. ;> M /   / V A f` / x l
P7)
    O gg $6
2 e g e L 2 E   2 .2 i ¤~ 2 3. E xg
Montli L_ ¤ ’Z`L'Z·` ·.l A E ,_ i> QO   E E _;
G G *3*** O t. 5 O E 5*** L : z S   G 9
EE cf: EE ce zz   msi 3;, EE gg
EE 52 E¤ ..7 ~¤e :·: 62:5 :5   :—~
,7:-: OE .-21 ~·¤; °~» rr »“—’ ;~ le ‘·’   ei
ltcport ull {uml alcridenlg in above lmluuk r¤pu<1‘l<·d on hack
··l` iliis rr·nort lllzmk and 1'7f‘ll[ in zi! the rnd of wrli month zxlonq
willi r·ilir~r ini`·wrinr1iim1 1·er;1ir·s I S U, S gg NATURE Op INJUAV
ll D — I— ` - OZ — D LII I-
I; E ( I- -— EJ) I-— hl O O E CD
' <( 51 IX };>;·¤ —* A-_ _ —   __' ___ lt-- R- _-__—— V—_—
IVQEPORTU TO THE STATE DEPARTMENT OF MINES
AND MINERALS A3 GET OUT IN SECS•   AND IEEE? W
  —.r»..—-*..;·—i———~ —-—— ·; -·———-—-—~-+——-·—-— j····;··_·  —·—* ·‘*
I3, KENTUCKY I/JINING LAW, ARE SUBJECT TO A I _ _~
FINE OF NOT LESS THAN   NOR MORE E- ___ _
THAN $YEO0.00» __' T Mi
  w_’—~I>" 1 I I.
, . I -..,.-——~—1~-—  
JOHN F. DANIEL, CHIEF  —-—~———-—--——-———-·~—-—-———~·~·—··— 
DEPAWTMENT OF MINES   MINERALS IF NAME OF COMPANY CHANGED DURING THE MONTH GIVE ITORMER NAME AND DATE CHANGED! L

 F0¤M B-—IOO
THIS IS THE PROPERTY OF THE STATE OF KENTUCKY AND MUST NOT BE DESTROYED
` MINE ORERATORIS MONTHLY REPORT
A1.s0 FATAI. ACCIDENT R;I¤0;zT
T0 TH; STATE O;;A¤TM;N·r 0; M1N;s AN0 MINERALS, LEXINGTON, I
< ; — - I·—· — O D I- 2 II. I O — I LL
2 2 0. E E K ;: LL - 0 cm 3 5 0 K
...I III ..I DZ III
C0 .1 In .1 < .1 m w un 4 0 2 In 1— g cn 0
2  2 0 III 0 2 0 . cs 5
OO 00 00 :J< 000... 0cI:c1|II10
*·O *-0 I—<.o Zen I—.1;>I— POI. XII;
 I ¤ #1 I »,·     ‘~ I   vi]   I’I- (_[¢I
/I»   ` A _’> I I1. I; /J ,.I I     I ‘_>I;—‘* /¤‘ ‘ I-III I ""
— " ` LII n ` In " III III TTT--
III ua U3 ..1 I cn I II 2 2 5
O Q O ID <( K I III LII .. III ·; K Q
Z LII Z O Z ··· 2 III (D I Z ID Q E E “" > III III
D I- Q III D UJ Z K ·-· K — IL K ID >
O- OI-U3 OU) LLZIII LI.`; b.III KU) ZL1. LI.O ILOUJ §O
CLE O.II1j) O.- ODK O OZ IIIZ IIJO O OUJ..I 3.1
_  — §
III >- III III LII III III III III I LII ·· III C) K .1 Q III — III K UI ..1 L1.I _
{U Q Q O3 Q. Q CQ O. CJ ED 2 [D I Ig X O  I I   I III {I QQ NATLHQE or I NI; wmv
LI · m Us I - I- I — » :1 - ;> II F
Ii I BC I I- ... I E3 I- I III 0 cd I    
'I ‘ I ...
AI_:st> FIITAL ACCIDEINIT Qaamnw 5 , é g I Q. ;(I 8 Ii é Q O I. _I -
»--— ·--»-T_-;—————--————--—-— ·—-—·————~··—I ———————-——- '··;——-··—·· ··~——~—~——- ——··—·-···-· —·’·····—+···—···—···;`.··‘....,_....•—·:.;...·"··......···——·*·—...........—···*·‘··"‘_.-..-*"*.*.·.—‘—‘.....·—‘—..*`
TO _ ____,,_.._ ,,...... .- .-_. -- .._--...>.-..., - .4-- ..-.....I ........-.,..I..-~...-.... - ..._.- ------—I-—-——--—-———+·——-—-——·-————-·————-—— ———-j-——-——————~———;———————-——-—-—————
. , —   -·I—··—··I;·——··V·— ·——‘_‘I"**_‘ I *_"‘"‘—"_"_"""‘“*""‘""_‘——""‘”‘— "_"`
;I·IAI·; DNNANTNIEINII or MINES ANI; I‘·IINE`F€AI.S (vg IICC1Ijm<;;;I   I
La XI NGTON , IF¤ N0 . OF MI NE) ~-»-——·—-—————·~·———·····—· ··—I·—·· —"—*‘ "“"’*"'_""`“’—""""`
)
( LO C fx T GI) /\ T ) __ ___ __ ______ ________  _ __________ ______________ ____________ ___________________________,__...r
CI w N Iv OI-i__V__A____l_____ _#___iM___r____;______________________ _ _____V_ M _______ I I _____ ____ ____   ___________________________________
TN I fj IIqI»IIm MUST B5 rerempmam PROIVIPTLY “”"`_” "`"` TI ` I I T I TIT-
II I g Nw II I- UICII IIINII III TO wg Dam NIMEIII 0 F ` I “ `TT ' ”"_"“` M "T_`“””"`I‘“I”“"“ "I"`“""" `I`“`_"` `_`_ `"_“`""“"`""_"'”""_"_` 'T`““T
. . %_____________ ____ __ WM I,__ __.,I .- -___ __.___ _..-;....I.--m._....*..-..-~-
I-.IIN;I: AND IIIIN;I¤¢.Ls, LEXINGTON. hm" . — .
..__...-..-...-_._...._ .-_.* .1_._I -,-I.._4 ..I..-.. _....- __....._.~...-_.;....I--~_ _--._*_....-.....F.I--
I I _;I; ______, ____-I_M
ALI. I¤;;¤s¤Na Ramsar Na m FUIQNI SH Twig; ·  ”" , I····—l""'
RHI PO V~ TS I —I‘ T HE ST/R TE OK P /\ F? TM5 NT O F` III I F~I€?S "—·~ ····*····—·——·—··-~··*——-—·· ···— ·*········;·—I········—···;‘ *·*— ·;——-——·I-—·~——- -·· ·———-——-———-—-··———-·—~···—·—··-··-··········i·"—""“—""""“"""' ` I
Mm I.II N rem Lg AG s:·T our I N Sam . I E AND ·—· -;·I~———-·——-······—··—·—~*··—···*—·"—‘ ‘I‘I ·“‘#‘—‘   
I IS , Ka; N TLI CK Y IIJII NI N I: LA III, Ia II;   BJ ac I TO II -—~——·—-——~—·—~———— ~ -———-———~— ———— ·~———— —»~—* ————-—- ——— ———-———————————-———-——-———~»—Y—I·—·~—-~~·
III IN; wr NIIT Lqsea THAN   . OO NOP mow;  ———-——·-·——--· ·-——··—-~—I···~-~·—  ···—·—·· ·—··-—————*———·—— -···—·~ ··~· ~~r··*···—~I #·*·*··· ** ‘·* M" HMK MM *‘‘I’‘ W
THA N SI-`OO IUI} . ———————»———»·-»————·-—   ——— -~———4--———————·——1———-———~—-~—~-·~—-~—--~~·#·· ···~·
II OHIII, R @I.II~—.I EL _ QN I ; p ,__________~_..____ _ ,_I_..IL*__;.___,#____,-_____.____.;I,__-,__+~- I.., I-I1;.w.;;;;;...w_;i;;;;;.;I
;**‘M·YT*»<%iNT ?V VI NES SI NI Ni?/\I.:I I Ir I`~I»¤:·.I; or C©m¤;IN»· QI—I:xN;a;© more I NG TI-IE ?.»IIi·NTI+   va FORMQQ NAM; AND DAT; CHANG;0: ___ _ __________W_____v__I_,_/

 FGFIA IE—IEC
THIS ES THE REOPEET`! OF THE SVATE YF  I'L'Q?`v' i‘—F`I`CJ IVILST NOT EE DESTF`O`Y’ED
M I NE OPERA TQj_  I\ICI\I`I`I;1L.i__j§_R_Cf?__T
ALSO FATAL ACCIDENT REYFCRT
TO THE STATE DEFARTMEFJTV OF MINES /—\I\I:} II/IINEI¥¥I·¥.L_9, LEXINGTON, I<`/..
IHIONTHLY DEPORT MUST BE IEILLED OUT COI/IF°LETE EACH MOI\ITI·I AND RETURNED TO THE STATE
DEPARTMENT O? MINES AND IIIINERALSII IN THE EVENT THE MINE IS NOT WORKING PLEASE
WRITE THE WORDS IINOT ORERATINGII ACROSS THE FACE OF THE REPORT AND RETURN TO THIS
OFFICE. ·
REPORT FOR MONTH OF_ ‘ _  
NAME OF OWNER OI? COMPANY REROHTING_ `______ I
NAME 0; IVIINE ‘ ‘ I _ COUNTY ' ` ____.____.___......
IMIINE POST OFFICE I I _____ __P. O. OF HEAD OFFIc;___ I ~ ~ » __
. /I_ I I   , _
NAME OF OWNER Ore OI¤;RAT0R · I ` _/- " — -.   -
NAM; OF II/IINE F0R;mAN · I ‘ * BEAM OF COAL I‘IIIN;u , ·
‘ I I D II I
UI O <(
LII I L3 UI O
Z I O C0 III III Z III Q
— O I I:1 02 In III - Q II .. [I I; III
I IJI X III Z III 1.I. 5; Z 4 (T § g_ III III ID
U Z   O Z C Z O [I (I OC - 1 Z D
IVIONTI-I § ; —- ·- I- _; O D I— Z II. I O -- In
I; 4 Q. E ; I1 3 II. - Q cm ;> :5 cI cI.
r W ..I III ..1 DC III
QJ gI.J _ ~I.I ,mm ~m· Z O II; O Z O C9 g
O C O O cr CI ;I < 0 C <*> - cg I; an II; :»
1-· Q _ I~- CJ I- <_>   .2 I;I I— ..1 ;> I· I—~ gg II X Q.
.I f/I `· / ’ ` I .1; I E4; I I I I II IPTIY TT
""'f_""` " ’*_" I ‘*"‘I_"*"‘  ""”""'_"‘
· I
L   I ...
T“_'I1 on III III
uu cn cn is I In I1 2 2 Z
D G O G] <( II III hl •- III "‘ EK D
Z III Z O Z - lj III (IJ Z LO Q   5; 2 )- III LII
D F 3 LII D U) Z OZ »— [IC — LL CC CD >
O- OI··*UJ CU) `LI.ZII| ILE LLII (IU} ZL:. LLO ILOUJEO
Q E O. lII_) (L ··- O D [L O Q Z ‘ LII Z III O C O (D.] D .J
< ..1 I   (JC .1 III I -5   -— Z.: III »- <[ Z (L
KZ @.10. Lau II; III C;:·OLf; I I— III IILI c‘;>, 3;
I II1 >- II1 III III III III I III III I II1 ·-- LII I O LI -1 Q III - III I; U .1 II.1
I U? CTI O Q O. O QQ Q O QI Z I CD Ij FI? X I] <; - Q) U) (U LII ..I q
E III 5: i ; III 5-II ;g·11;;¤I.II1I Fw ;I—· >;I;II·I—z
3**-(D QLLO I QL}? QIZ ;>IRn:»Arw ____i_ _ MIN; _ AUCOUNTY _____----,....
I‘IOW TIIE IEATALITV "JCCLIRFEQO III.} DET/\II.._-_,_______.______________, ___ _____________,,_,..-,,,..__._...-
REPORT ALL FATAL ACCIDENT? IN ABOVE BLANK SPACE
AND MAIL. II/TNIEDIATELY TO THE LEXINGTON OIEFICE. SIGI\I€D_______, -
TI TI.; ____ ______
ALL NCN—FAT/‘·I. ACCIDENT? OF WHATEVER NATURE TO BE RETJORTED ON BACK OV THIS I;*?ZV`ORT
BLANK AND SENT IN AT THE EMD OF {ACH MONTH ALONG IAII TH OTHER INFORNIATICN REQUESTED
ON THIS B\.A.NI<,

 - I r   _ I I _ ., , , ,. v
Fzcm R~IUG REPORT OF NON.FATAL ACCIuEmTS DURING T¤E MONTR OIT ~&Y _w, IQ}? __
—- ———————-——-————·····* " ‘·—‘·‘·"* ·—····————_***·"*—”‘T’ —’**?·""—·`;i
.. ... A- I.? I ~»» I _ ”  “"—`** ’ I- I I I
IVII II; UP ;.r¤A I uri ‘ In I   III I I
· · I-
I I Q   I I I I Z IT I
MONTHLY REPORT NAM; I Q E · Q > I I g I M Q § NATuR; OF INJu¤w
III   cm I - I- I D - ft — D I LII I-
I— I cc I I— .. I 0 I- I III 0 8 I 2 C2
ALS0 FATAL Ac;:I¤:I—IT REPORT _ § I Q g   5 :I' 5 Ei . é   Q I I: L I ·
TO ___ _____ _»_ _________ _____ _1______Y____,__I____________I____ __I___ ___ ~ _____I__.____.._.I_-..__;.........._........—... 
{N0 hf)CI.CIF}:‘I`I}SI
, - . ——··————-— -—-———-—i--—-— — ———-——-7*- ·—··—‘—I··"""‘  *""‘_‘—‘—_"‘_—°"—‘*°`
IITAT; UFPARTIWEIQT Or IMIINES AI:0 I¢III—I;RAI_s - I I
_ I ___ _________ ______ ___________’___ _______ ___,r_______\I_ ____r,__ _,L_ _,_ ___. ,,,..,,....-.I-~..,_.......-..-,, .... ...1+... ih-·—-·—· »— -—- t-~ —-··—-;—-l-»·-—-———----¤——·-·—- ~t———--—~ ··;""
LEXINGTON, KY. I I
 R»  ~—— —~————————~——II——~—I~ I _ I
II'I(`)I·I TR- CIF _____¥___ ___ _ __I   ____ _ —-——»—-———-———»———--—— -——I——-- -———-——I———————— ———— ——— —·——· ——·—-———·——-·-—-·—·-—······—·····—····——···········—
I I
AI, I
I I\·I/\I`AE;i OF OWNE R O R COMPA NY) H-_‘-w——_ -__——-M- I-.-—-A   —_———_--—`—>—•—_u_   —-lm-_
I _____________
(Lmczx TKO A T I · __ I ____ ___________,.,_.,.,I____.__...._..............I
IDI. IIJ N TV OIT _ __!_________________________________________________ r_I _'>;_-___m_I»__* _" W __ V 1_____ I __________ 
I I . _________..-
THIS IIEFIITFQT MUST BE FOFIVI/AFTDEZD PROMPTLY __' —- I '
A T Er NL) (I F if/\ CH I/IO N T*I TO TH E [IEP A R TI`/1EfN T O F _ -·_>·_r__—r>_-r_»-_ _ —_v—_T-“_ _" - MDW r— - ’_ _
III I N i' S A NI) III I Ni I4/\L_ Si L   X I N G TO I‘—I . "”*"”—_ ”`—;`”`“ '-?`·T”—`_` ;—-_ `—"`~>—_`_I"A —
I I  
--——·- .T-»;j-—..--—-*—-» ·t--·.r~—-- · --~—-; -;-~·---.-.-;I.-.—--——- —-—·-—··——· —-·--——————;·--·»-——--·——-·-» ———-——-————— ·——-——··—-—·-—·~———·——·*"--
________________ _____ I“__  
ALI. I¤€`F2!§OI·I5`$ IREFLIESI NG TIT FLIRN I SI-I THESE - U I
Rai VIII I-‘ T1] I I‘ T II? S>TATi UK F’!II?TI—A€NT OF MI M55 ~~—~———-————·————--——#—~————————· ———— ———--——-— »I·—-——— ~————·——·- ————————-——— —·——·*·`·*——TT"‘
/`— ND I.II IJVIQ/\ L1;} ATT SRT OUT I N   ., I 2 A ND ’—'“‘ “ "‘I"‘"""”" "*;'“;""""T""_"""'“""`"_"T'_"—"`”_T_-`_r_>
I S , Kei w TI} cI< Y IA I N I NG Ln   , A rc; gu BIT ac T TC A -— I———--—·~————~ —-——·-——— ————~—— —··— . ·-——-·-—-·- --— -——~———— ———— ——~—-——~-··-——-—-———·———-———»—· 
V I IU II F NIT T I_   III; THA N $93 . GCI MO R MO IIE —-—·-—·-~—·—— ———··-· · ·I~-·—·—·’ ···*—···· ·—·········· —·4·* ·—····*—*“·’ *··’* **6***1*** T—*"_’T‘ "‘T`"""T‘ ""“““"‘”"‘"
THA N (S; DO .I]‘IRI . »-~--»-~—-——~—-———-—»——— -—-— ———-··-   —»— ·I—-— —-— -——·—~#——~—·—··~#····
J Cr In IT , OA °I. I E I_ _   I g Ir r___m- _._f__.._._,___,-._..,____....L ,_________ _ __.M._.  ,........._.-_.,....,-4n--.»..»-*~»w~»- -1;
CIF I*»’\FITII—*€SNT "F VII NEI? F- III! T-IZRALCI I F NAIA; Or COIAQAIIJV CRANI3;0 mum :~I<; THE I.`IONTI—I GI VE FORMER NAME AND DATE CHANGED? _ _ __________________,_,______,_

 ?I¤·.1$—l’i
TEE? lf? THE 3iC@E'·T`/ CIF TIEE CTATE TF I'¤T mw :1a©IwII or ___ _ _ ____W _ _ _4_ IQ} _[;______
‘ 7/ ',"""' ‘“` "' '
_ X , ' I
in/IM; OF OvvN€R 012 C—’JI~.@F>»‘·NY REPCF?TIN‘°_ ,_/_Agr;,‘ " ·_ I· ~. _;______ ___________________________
I—.III.I; 0: MI NE ___ _ _ _ ___ __ _C0uI~I·Iv__;;;__;_____;_»_____________E__
,/I  
f‘.‘I NE POST Crm cg ___ji;_____________,_____________;__________F. C. OF I—I;A0 CIFIFI c;_________________;_____ ____
NAME OF OWNER OV? QWER/`ITCIIY I ___ · I    
@_m.c; mr I/IINE Fonawme . _ S=;gg__0F C0¢;L IVIINED   I
I O LI I
LII O -   0 III rw I ;;‘ O I5 E
O Iii;   O C   ~ ;> < I` I: 1* - I cg   J III LI
_ IE <-J I I~·  III III
Q I· D III D U} Z (I jg UL — L; {L CD >·
QJ T O I- CD O UI I LI. Z III 14.:; IL III CI UT Z U. ls.   LI. O U)   O '
U-. Z U- lll E) Q. -— I O D U. O O Z III Z , III O O T IT U) .1 D .1
< .1 5 I cr .1 III A- I -— L_ III .. 4 2; I1
III Z II .1 II K K II III [I Z I; I; I— III II LJ CI > -— E
II. > III LII LII III III III III I III —·- LII C) IX .1 IQ III - III II O .1 III,]
l HQ O Q IQ Q. Q CII Ll LI I;. FT I {IJ I ID X O I  I— 2;-:
._.T...L...,..I..L. I I . ... .._ -...
( ' ,   · I . "   I fl ' ’  
._;I““I*—   ’*I  ***I  ”*I    
I I I
LL ___L.._.i....._ __,___..,_,___-__,__,..._,.__
-..._ 
******** FATAL ACCIDENT REFORT *******1*
SHOULD FATAL ACCIDENT <1T1CCI,,‘F<, PLEASE FILL IN TIIE SPACE BELOI/'J AND MAIL IIJIMEDIATELY TO
THE LEXINGTON GFFICE
NAME OF F’EF¥’S'Y?*J KILLED _ iw-. _ AGE____ _____
III/XIQIQI ED OI? SI NGLE * _ _ __ DEF€I\1C`=€NT€ NAT! ONALI TY __
OCCUP/\Tl (UN_ ___LENGTH OF TIME IN SERV! CE __ _ ____
TOTAL MINING EXPERIENCE ____ _______________ _ _ ______ ______________
17 - . ,. IT .. -
IJAT; UF ACCID;NT ,-.7- I- CAT; OF DEATH W-; •_'_
I¤· - -
INI TI\1;$$;.S ____
EXACT LOCATION WHERE ACCIDENT OCCURRED ____ ________________,_._.....
STATEMENT OF INJUEED FEEFSTON -_-*~ ·•"_ ___ _____
IJAIWF OF »¤iIG¤ITAI_ ?¤eiI=:T IF, IF /II»:`—r __ __ _
l`—11‘~M€ 'EF C’7w:¢·AI\:v_____ __ _ HIXIINE _*__ _______r_CS·?UIY`V\’_v_______L_,__.,......
LTOW TME Ff=T»"~I_I TY CICCUEVED IIJ DETAIL. .... -,_,__,_____L___________________.,_..__L.L..,_..-....--...—_---
'TEPVFT ALL FAT/?·I_ ACCIFE?IIT" 11*1 AFECVE BLANK SPACE
IYNO I.11\lI_ lI.I"·A§_OI13TTl_`{' T" THE LEX] IIIQETCIN OFFI CE. $|GT*1iD _....
TI TLE  _____________________-_
ALI- NFII~I—Ff»Tf.I_ AI;CI€Jir.T$> UF w+1¤T;*\/gi I»;ATI,¤e;; TJ BE R;;I¤Ci»F."IZ? T I I I LI! Z Z Z IU II ,.,,.  
VI»}T~ "L-T T ; J'   I ___ __ I O >_ I O hl O C NATUY\1    
ET TTUTIFTT B;ITI.63I @5
- I1 ~ ·-· I . . L I
,. ,_, , ‘ O -· .;; II .. —I
AI_$; ITAT/\I_ ACCID:.·¤TT Q:f>@T?T 5 I 2; Ig I é Z;] Q E   g ;·¤reT’Q  __ ;M__________  _4______j;________Q;Q__A______ W I _` _ ____ __________ _____ ________________
, I —-.,;.._.._..... T. _ .... .._......—-—._.;-..—-.-.---....-Q-—~
IHI S; HTPCTFQT FALTLET B5 FOQVVAQDED PFQOMPTLY I
A T F. NLT LTV E, ACI-I MON TLT TO THE DEP/\ RTMEN T O F n' ·__ 4.—r7—·A—_~— *A—_- I-"___—hI~·_“—_ __" - TTT —_* __' WMUTT _—— T -
III I N; Y? A HU IJI N { IQ,/XL S , Li X I N G TO TQ .  "‘_'"""""";‘°°;" “`"_"‘_ "”"'""'I'"“"“ _“"`   "_"_“`""’_“ ’“"_”`TT;T“_T`T
AL L, FT€;HSfTNi—; RQFLJSI NTB TO FUQN I QH TEIFSE A   . “_` -_" vw--.
Fw? P TT TT T :3 IWVT THE STATE :)ijV*APYT'f‘.·1ENT OF NTI M25 ··—~—-—·-;—·———--——-—— —~·——— ·————· -—-——»——-I----—-—· ·———-— —-—~———-· --——— —-;-——-——-—·--————-——~——-——-—-——~·—~———-—-·—~·—·——·—·T#· H
A ND I`.TI N {WWA I QT AST ST   T CTL» T T I~T S {ij;} . I   A ND ‘—·~;···l·" "‘ ·—···I····· ·*·——‘ —·-·—-—····—‘··*"‘·-‘·*j*‘··"‘*·*"‘**"""""*"* "`
I S , I/vim wow v M = M I me: Ln   , A @2;   sq ;cT IT; A Y—·——»·—-·——·——— ——~—;~——- —-——— —————»———T——~-—~—~ ·————-—-— —— -————·»—~———-—-———————-—·————~—~—E~—T—E———~·—··
E1 Ie; w F NI I T Len: 51 TITAN rE  . {TTT rw S mc ng -~·-  —-———[—»—-·———-·» —-·—— —————~———- ——~— ·--·—··—~~~——~&··-—~—-—· —·~—·~-—· YT #~~·~~—···#~~···—T· T*··   ·
TIM N Si DO . TQ"? . ——»-—»—--»--—-»~--»·——-1*- -——- —-—--KI.-·——-— .—·——~—.—·———-——·——-—-—-——---——-—-——»»»—··-—~~-
I
I_L_________________,_ ______j_L____ _,___ ___I”____________________,__L__TI__,_._,__L_.._.-LI.-L
L;C·#?=I   CNHI EL _ j¤ I 5 r ...-,_.__,_wL_.__._ __,,______;______.__._.._..,_L#._,_ ___L________;__________,_____,..,_.._,.E,44,_LL_.-.-__..U,,--- E..».rr I
3 T‘»*T"T`··T?TT~T TTF `W! ‘<€*i ’· INT F—T¥‘¤»T Lz I Ir Im:-.a; 0: COI‘—.’i¤,*IN\’ Q~¢Ima;¤ www I nr; ws; TT.:II\m·I GI va Fcvcmzm Nzxm; AND DAT; CHm~1@;0: _______4___A___E V _A

 YI ¤·c   I.
`HI;E> IC THC ¤EiI::;’—T*I OF THE ;TATC `IT ¥<1¤.rII1‘I. I;»ORTING_ _____________________________________________________V_____
I—;A>.IE Or IIII IIE ___» _____ __ __ _ _CC'UNTY____________‘ __E___E__EE__E_E-__
I·.“I III; POST Crm C; __*____________,______ _____ ___ P. C, Or HEAD LJFFI I;E__.___