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DEATH
CERTIFICATE
FRED COBURN
Date 12 December 1945
Cert: 25337
Place of Death: County: Fayette City or
Town: Lexington
Name of Hospital or Institution: Eastern State Hospital
Length of stay in hospital or community: 10 yrs, 09, mos, 17
days
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Handshoe
Full Name: Fred COBURN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 1921
Age: 24 years
Birthplace: Unknown
Occupation: Student
Industry or business: (blank)
Father Name: Irvin COBURN
Father Birthplace: Unknown
Mother Maiden Name: Elsie------COBURN
Mother Birthplace: Unknown
Informant: Hospital Records, Lexington, Kentucky
Burial Place: Hazard, Ky.
Date: 14 December 1945
Signature funeral director: Lowe F. Home, by
Merault Marlis, Lex., Ky.
Date received by local registrar: 14 December 1945
Registrar's Signature: D. A. Furlong
Date of Death: 12 December 1945
I hereby certify that I attended deceased from October 1941 to
12 December 1945, that I
last saw him alive on 12 December 1945, and that death occurred on the date
stated above at 1:00 a.m.
Immediate cause of death: Chronic Myocarditis
Due to: Psychosis with Mental Deficiency, Imbeclie
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: Owen F. Kneppen, M.D., Eastern State
Hospital, Lexington, Kentucky
Date signed: 12 December 1945
Transcribed by Debbie Tamborski, 09 February 2010 |
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