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 |