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DEATH
CERTIFICATE
J. D. COLLINS
Date 18 February 1942
Cert: 03226
Place of Death: County: Floyd City or Town:
Martin
Name of Hospital or Institution: Beaver Valley Hosp.
Length of stay in hospital or community: 10 days
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural (Dema)
Full Name: J. D. COLLINS
If Veteran Name War: (blank)
Social Security No.: 404-093736
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Edna COLLINS
Age of husband or wife if alive: 24 yrs.
Birth date of deceased: 25 August 1917
Age: 24 years, 05 months, 24 days
Birthplace: Knott Co., Ky.
Occupation: Janitor & Handy man
Industry or business: (blank)
Father Name: E. B. COLLINS
Father Birthplace: Floyd Co., Ky.
Mother Maiden Name: Cula SPENCER
Mother Birthplace: Floyd Co., Ky.
Informant: E. B. COLLINS, Mt. Sterling, Ky.
Burial Place: Wayland, Ky.
Date: 20 February 1942
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 28 February 1942
Registrar's Signature: Mrs. Ben Norris
Date of Death: 18 February 1942
I hereby certify that I attended deceased from (blank) to 18
February 1942, that I
last saw him alive on 18 February 1942, and that death occurred on the date
stated above at 6:00 p.m.
Immediate cause of death: Intestinal obstruction
Due to: Cicatrix (ulcer)
Major findings of operations: Obstruction (duodenum)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Edward R. Codden, M.D., Martin, Ky.
Date signed: 27 February 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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