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DEATH
CERTIFICATE
ADAM CAMPBELL
Date 30 April 1949
Cert: 10508
Place of Death: County: Perry City or
Town: Hazard
Length of stay in hospital or community: (blank)
Name of Hospital or Institution: Mt. Mary
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Hindman
Full Name: Adam CAMPBELL
Date of Death: 30 April 1949
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 28 August 1876
Age: 73 years
Usual Occupation: Retired
Kind of Industry or business: Lawyer
Birthplace: Knott County
Father's Name: Jasper CAMPBELL
Mother's Maiden Name: Naomi SMITH
Was deceased in ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Mrs. Adam CAMPBELL
Disease or condition directly leading to death: Respiratory
failure
Due to: Pneumonia, senility
Interval between onset and death: (blank)
Other significant conditions: Malnutrition
Date of Operation: (blank)
Major findings for operation: (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 (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank), from the causes
and on the date stated above.
Date signed: 02 May 1949
Address: Mt. Mary Hosp., Hazard, Ky.
Signature: (illegible) M.D.
Burial, Cremation or Removal: Buried
Date: 01 May 1949
Name of Cemetery or Creamatory: Engle
Location: Knott, Ky.
Date received by local registrar: 03 May 1949
Registrar's Signature: Helen C. Burriss
Funeral director and address: Engle's, Hazard, Ky.
Transcribed by Debbie Tamborski, 15 February 2010 |
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