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DEATH
CERTIFICATE
KENNETH D. DISNEY
Date 16 July 1941
Cert: 18414
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Vicco
Full Name: Kenneth D. DISNEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 13 July 1941
Age: 03 days
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: J. R. DISNEY
Father Birthplace: Knox Co., Ky.
Mother Maiden Name: Alice MAGGARD
Mother Birthplace: Knox Co., Ky.
Informant: (blank)
Burial Place: (blank)
Date: (blank)
Signature of funeral director: (blank)
Date received by local registrar: 28 July 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 16 July 1941
I hereby certify that I attended deceased from 15 July 1941 to
16 July 1941, that I
last saw him alive on (blank), and that death occurred on the date
stated above at 1:15 p.m.
Immediate cause of death: Cerebral hemorrhage
Due to: (blank)
Major findings of operations: (illegible)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Chris S. Johnson, M.D., Hazard, Ky.
Date signed: 21 July 1941
Transcribed by Debbie Tamborski, 01 February 2010 |
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