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DEATH
CERTIFICATE
ARCH B. DAVIDSON
Date 29 February 1936
Cert: 05891
Place of Death: Voting Pct.: Hazard Hospital Co.,
Hazard, Perry Co., Ky.
Full Name: Arch B. DAVIDSON
Residence: Carrie, Ky.
Length of Residence: Life
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 22 January 1916
Age: 20 years, 01 months, 17 days
Occupation: C. C. C. enrolle
Birthplace: Knott County Kentucky
Father Name: Orlando DAVIDSON
Birthplace Father: Knott County
Mother Maiden Name: Nettie COMBS
Birthplace Mother: Perry County Kentucky
Informant/Address: Orlando DAVIDSON, Carrie, Ky.
Burial Cremation Removal Place: Burial - Carrie, Ky.
Date: (blank)
Undertaker/Address: Engle Bros., Hazard, Ky.
Filed: 04 March 1936
Registrar: J. P. Boggs
Death of Date: 29 February 1936
I hereby certify, That I attended deceased from 11 February
1936 to
29 February 1936, that I last saw him alive on 29 February
1936, death is said to have occurred on the date stated above,
at 3:10 p.m.
Cause of Death: Bilateral lobar pneumonia complicated
with double otitia media and empyema, left side
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: None
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: J. E. Hagan, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 18 April 2010 |
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