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DEATH
CERTIFICATE
JANE BOLEN
Date 07 February 1951
Cert: 03082
Place of Death: County: Johnson City or Town:
Paintsville
Length of stay in hospital or community:
Name of Hospital or Institution: Paintsville Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Bolyn Street Address:
(illegible)
Full Name: Jane BOLEN
Date of Death: 07 February 1951
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth: Unknown
Age: 78 years
Usual Occupation: (blank)
Kind of Industry or business: Housewife
Birthplace: Knott Co., Ky.
Father's Name: Jack(illegible) GAYHEART
Mother's Maiden Name: Peggy CONLEY
Was deceased in ever in armed forces: no
Social Security No.: none
Informant: Kendall BOLEN
Disease or condition directly leading to death:
Pneumonia
Interval between onset and death: 01 day
Due to: don't know
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings for operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: Paintsville, Johnson, Ky.
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 06 February
1951 to 07 February 1951, that I
last saw the deceased alive on 06 February 1951, and that death occurred on
the date stated above at 7:15 a.m., from the causes and on the date
stated above.
Date signed: 07 February 1951
Address: Paintsville, Ky.
Signature: Saul B. Hall, M.D.
Burial, Cremation or Removal: Buried
Date: 09 February 1951
Name of Cemetery or Creamatory: Family
Location: Bolen, Ky., Knott, Ky.
Date received by local registrar: 13 February 1951
Registrar's Signature: Madge Salyer
Funeral director/address: Hindman Funeral Home, Hindman, Ky.
Transcribed by Debbie Tamborski, 17 February 2010 |
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