Date: 28 October 1941
Cert: 29457
Place of Death: County: Knott City or
Town: Lackey
Street No. or Location: Rural
Length of stay in hospital or community: 03 mos.
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Lackey
Full Name: Gairl CONLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 August 1941
Age: 02 months, 19 days
Birthplace: Lackey, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Johnnie CONLEY
Father Birthplace: Handshoe, Knott Co.
Mother Maiden Name: Cora HANDSHOE
Mother Birthplace: Handshoe, Knott Co.
Informant: Johnnie CONLEY, Mousie, Ky.
Burial Place: Handshoe, Ky.
Date: 30 October 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 28 October 1941
I hereby certify that I attended deceased from 27 October 1941 to
28 October 1941, that I last saw him alive on 28 October 1941, and that death
occurred on the date stated above at 2:00 a.m.
Immediate cause of death: non specific diarrhea
Duration: 02 weeks
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: C. R. Messer, M.D., Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 12 October 2010 |