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DEATH
CERTIFICATE
MARJORIE BUFFALO
Date 17 July 1943
Cert: 21032
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Allock
Full Name: Marjorie BUFFALO
If Veteran Name War: no
Social Security No.: none
Sex, Color or Race, Marital Status: Female, White, (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 04 February 1943
Age: 05 months
Birthplace: Vicco, Ky.
Occupation: Infant
Industry or business: (blank)
Father Name: Bill BUFFALO
Father Birthplace: Italy
Mother Maiden Name: Elizabeth MITCHEL
Mother Birthplace: Tennessee
Informant: Bill BUFFALO, Allock, Ky.
Burial Place: Rose Hill Cem.
Date: 19 July 1943
Signature of funeral director: Maggards, Hazard, Ky.
Date received by local registrar: 01 September 1943
Registrar's Signature: Anna L. (illegible)
Date of Death: 17 July 1943
I hereby certify that I attended deceased from 17 July 1943 to
17 July 1943, that I
last saw him alive on 17 July 1943, and that death occurred on the date
stated above at 7 p.m.
Immediate cause of death: Bronchial pneumonia
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 20 July 1943
Transcribed by Debbie Tamborski, 05 February 2010 |
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