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DEATH
CERTIFICATE
ED BEVERLY, JR.
Date 12 July 1948
Cert: 27891
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Mt. Mary Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Wiscoal
Full Name: Ed BEVERLY, Jr.
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 01 years, 01 months
Birthplace: Wiscoal
Occupation: (blank)
Industry or business: (blank)
Father Name: Ed BEVERLY
Father Birthplace: Diablock, Ky.
Mother Maiden Name: Hazel TAYLOR
Mother Birthplace: Car, Ky.
Informant: Ed BEVERLY
Burial Place: (blank)
Date: (blank)
Signature of funeral director: (blank)
Date received by local registrar: 10 June 1949
Registrar's Signature: Helen C. Burriss
Date of Death: 12 July 1948
I hereby certify that I attended deceased from 12 July to12
July, that I
last saw him alive on 12 July, and that death occurred on the date
stated above at ? (transcribed as written)
Immediate cause of death: acute gastro enteritis,
Bacterial, severe diarrhea
Due to: (blank)
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: W. O'Donnell, M.D., Hazard, Ky.
Date signed: 14 October 1948
Transcribed by Debbie Tamborski, 14 February 2010 |
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