Date:  16 November 1953
Cert:  23319 
Place of Death: County: Knott      City or Town: Lackey, Ky. Rural
Length of stay (in this place): (blank)
Street address or location:  Stumbo Memorial Hosp.
Usual Residence of Deceased: State: Ky.     County: Knott
City or Town:  Carrie      If rural give location: (blank)
Full Name:  Jack DAVIDSON
Date of Death:  16 November 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth:  09 March 1870
Age:  83 years
Usual Occupation: Farmer
Kind of Industry or business: (blank)
Birthplace:  Knott Co., Ky.
Father's Name:  Edward DAVIDSON
Mother's Maiden Name:  Liza WALKER
Was deceased ever in armed forces: (blank)
Social Security No.: 404-16-8063 A
Informant:  Arminda DAVIDSON
Disease or condition directly leading to death:  Uremia
Interval between onset and death: ? (transcribed as written)
Due to:  Hypertensin & kidney disease
Interval between onset and death: ? (transcribed as written)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy:  (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 15 November 1953 to 16 November 1953, that I last saw the deceased alive on 16 November 1953, and that death occurred at 11:45 p.m., from the causes and on the date stated above.
Date signed:  20 November 1953
Address:  (blank)
Signature:  Eldon Dyless, M.D.
Burial, Cremation or Removal:  Burial
Date:  17 November 1953
Name of Cemetery or Crematory:  Combs Cemetery
Location:  Carrie, Ky.
Date received by local registrar: 25 November 1953
Registrar's Signature:  Mrs. Rose B. Craft
Funeral director & address:  John Everage, Hindman, Ky. 
Transcribed by Debbie Tamborski, 07 February 2011