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DEATH
CERTIFICATE
SHELLEY H. DAY
Date: 11 December 1952
Cert: 24847
Place of Death: County: Bourbon City or Town:
Rural
Length of stay (in this place): (blank)
Street Address or Location: Clintonville
Usual Residence of Deceased: State: Ky. County:
Bourbon
City or Town: Rural Street
Address: Clintonville
Full Name: Shelley H. DAY
Date of Death: 11 December 1952
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 29 April 1896
Age: 56 years
Usual Occupation: (blank)
Kind of Industry or business: Farmer
Birthplace: Knott Co., Ky.
Father's Name: David DAY
Mother's Maiden Name: Lurania SMITH
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Mrs. D. C. BLACKBURN, Lexington, Ky.
Disease or condition directly leading to death:
Arteriosclerotic Heart Disease
Interval between onset and death: (illegible) years
Due to (b): Auricular Fibrillation
Interval between onset and death: 03 months
Due to (c): Congestive Heart Failure
Interval between onset and death: 02 months
Other significant conditions: none
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: no
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 20 October 1952
to December 1952, that I last saw the deceased alive on 03
December 1952, and that death occurred at 1:15 am., from the
causes and on the date stated above.
Date signed: 12 December 1952
Address: Lexington, Ky.
Signature: (illegible) M.D.
Burial, Cremation or Removal: Burial
Date: 13 December 1952
Name of Cemetery or Crematory: Winchester Cemetery
Location: Winchester, Ky.
Date received by local registrar: 13 December 1952
Registrar's Signature: Lavalette R. Orr
Funeral director & address: Davis Funeral Home, Paris,
Ky.
Transcribed by Debbie Tamborski, 11 August 2010 |
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