|
DEATH
CERTIFICATE
RODA DISON
Date 09 November 1940
Cert: 29776
Place of Death: County: Perry City or Town:
Hazard, Ky.
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural Street No.:
18
Full Name: Roda DISON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: W. A. DISON
Age of husband or wife if alive: 46 years
Birth date of deceased: 21 February 1899
Age: 41 years, 08 months, 19 days
Birthplace: Knott Co., Ky.
Occupation: House wf.
Industry or business: (blank)
Father Name: William EVERAGE
Father Birthplace: Letcher Co., Ky.
Mother Maiden Name: Roxie MULLINS
Mother Birthplace: Letcher Co., Ky.
Informant: W. A. DISON, Bulan, Ky.
Burial Place: Burial - Clear Creek
Date: 11 November 1940
Signature funeral director: Engle Und. Hdwe. Co., Hazard, Ky.
Date received by local registrar: 10 December 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 09 November 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: diffuse peritonitis shock
Duration: (blank)
Due to: (illegible) ovarian abscess - left, Cys(illegible)
ovary - left
Major findings of operations: above at (illegible)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Chris S. Jackson, MD, Hazard
Hosp. Co.
Date signed: 29 November 1940
Transcribed by Debbie Tamborski, 08 May 2010 |
|