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DEATH
CERTIFICATE
JAMES CLEMONS
Date 09 April 1948
Cert: 06924
Place of Death: County: Boyle City or Town: Danville
Name of Hospital or Institution: Kentucky State Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Cordia
Full Name: James CLEMONS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Arizona CLEMONS
Age of husband or wife if alive: (blank)
Birth date of deceased: 1913
Age: 35 years
Birthplace: Breathitt Co., Ky.
Occupation: Coal Miner
Industry or business: (blank)
Father Name: CLEMONS
Father Birthplace: (blank)
Mother Maiden Name: Jannie CLEMONS
Mother Birthplace: Hardshell, Ky.
Informant: Ky. State Hospital, Danville, Ky.
Burial Place: Cordia, Ky.
Date: 12 April 1948
Signature of funeral director: J. Vernon Kerrigan, Danville,
Ky.
Date received by local registrar: 10 April 1948
Registrar's Signature: John D. Nichols by J. O. Kemper
Date of Death: 09 April 1948
I hereby certify that I attended deceased from 05 April 1948
to 09 April 1948, that I last saw him alive on 09 April 1948,
and that death occurred on the date stated above at 6:30 p.m.
Immediate cause of death: Hemorrhage
Due to: Peptic ulcer
Other Conditions: Cirrhosis of the liver
Major findings of autopsy: Cirrhosis of the liver
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Dr. T. (illegible) Torre, Kentucky State Hospital
Date signed: 10 April 1948
Transcribed by Debbie Tamborski, 14 February 2010 |
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