Date: 10 February 1946
Cert: 06992
Place of Death: County: Knott City or
Town: Bolyn, Ky. Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Bolyn Rural
Full Name: Johnie CHARLES
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: None
Age of husband or wife if alive: (blank)
Birth date of deceased: 05 August 1943
Age: 02 years, 06 months, 05 days
Birthplace: Caretta, McDowell Co., W. Va.
Occupation: None
Industry or business: (blank)
Father Name: Henry W. CHARLES
Father Birthplace: West Virginia
Mother Maiden Name: Ethel RATHNIE
Mother Birthplace: West Virginia
Informant: Helen Louise BOLYEN, Bolyn, Ky.
Burial Place: In Coburn Cem., Bolyn, Ky.
Date: (blank)
Signature of funeral director: None
Date received by local registrar: 06 March 1946
Registrar's Signature: Mrs. Rose. B. Craft
Date of Death: 10 February 1946
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)
Immediate cause of death: Something wrong with its spine
and arms. Mother started to take child to Hosp. or
doctor but he died on the way.
Duration: (blank)
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 & Address: J. W. Duke, M.D., Hindman, Ky.
Date signed: 30 March 1946
Transcribed by Debbie Tamborski, 04 December 2010 |