Date:  15 September 1950
Cert:  18770
Place of Death: County: Knott      City or Town: Rural
Length of stay (in this place): 02 hours
Name of Hospital or Institution: Stumbo Hospital
Usual Residence of Deceased: State: Ky.     County: Knott
City or Town:  Rural    If rural give precinct:  Elmrock
Full Name:  Clayton BOLEN
Date of Death:  15 September 1950
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth:  04 November 1949
Age:  10 months, 09 days
Usual Occupation:  None
Kind of Industry or business: None
Birthplace:  Knott Co., Ky.
Father's Name:  Hubert BOLEN
Mother's Maiden Name:  Hattie SMITH
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  Hattie SMITH
Disease or condition directly leading to death: Pseudomonas Enteritis
Interval between onset and death:  (blank)
Due to:  Pseudomonas Aerogenes
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 15 September 1950 to 15 September 1950, that I last saw the deceased alive on (blank), and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  25 September 1950
Address:  Lackey, Ky.
Signature:  C. M. Aker, M.D.
Burial, Cremation or Removal:  Burial
Date:  17 September
Name of Cemetery or Crematory:  Family
Location:  Elmrock, Knott, Ky.
Date received by local registrar:  04 October 1950
Registrar's Signature:  Rose B. Craft
Funeral director & address:  John N. Taul, Director, Hindman Funeral Home
Transcribed by Debbie Tamborski, 10 January 2011