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DEATH
CERTIFICATE
CAROL BAILEY
Date 04 September 1942
Cert: 21026
Place of Death: County: Pike City or Town:
Pikeville
Name of Hospital or Institution: M. E. Hosp.
Length of stay in hospital or community: 06 days
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Hindman
Full Name: Carol BAILEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 January 1941
Age: 01 years, 07 months, 19 days
Birthplace: (blank)
Occupation: Infant
Industry or business: (blank)
Father Name: Kenneth BAILEY
Father Birthplace: Hindman, Ky.
Mother Maiden Name: Goldia BOLWING
Mother Birthplace: Garrett, Ky.
Informant: Kenneth BAILEY, Martin, Ky.
Burial Place: Hindman, Ky.
Date: 06 September 1942
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 16 September 1942
Registrar's Signature: Anna Justice (illegible)
Date of Death: 04 September 1942
I hereby certify that I attended deceased from 28 August 1942 to
04 September 1942, that I
last saw him alive on (blank), and that death occurred on the date
stated above at 2:10 p.m.
Immediate cause of death: Terminal bronchio pneumonia
Due to: Whooping cough
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: Frank C. (illegible), M.D., Pikeville, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 02 February 2010 |
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