DEATH CERTIFICATE

 LOU JEAN BENTLEY

Date:   13 December 1942
Cert:   01851 
Place of Death: County: Knott     City or Town: Lackey
Name of Hospital or Institution: Stumbo Mem. Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Floyd
City or Town:  Wayland
Full Name:  Lou Jean BENTLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  10 March 1939
Age: 03 years, 03 months, 03 days
Birthplace:  Wayland, Ky.
Occupation:  (blank)
Industry or business: (blank)
Father Name:  Corbet BENTLEY
Father Birthplace:  Sydney, Ky.
Mother Maiden Name:  Mary PATTON
Mother Birthplace:  Knott Co., Ky.
Informant:  (blank), Wayland, Ky.
Burial Place:  McDowell, Ky.
Date:  14 December 1942
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar:  01 February 1943
Registrar's Signature:  Ida Livingston
Date of Death:  13 December 1942
I hereby certify that I attended deceased from 10 December 1942 to 13 December 1942, that I last saw him alive on (13 December 1942, and that death occurred on the date stated above at 10:30 a.m.
Immediate cause of death: Peritonitis
Duration: (blank)
Due to: Ruptured appendix
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. R. Chitwood, M.D., Lackey, Ky.
Date signed:  29 January 1943
Transcribed by Debbie Tamborski, 15 October 2010