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DEATH
CERTIFICATE
JIMMIE RAY ELLIS
Date 20 December 1936
Cert: 8421
Name: Jimmie Ray ELLIS
Place of Death: Voting Pct. S.M. Hosp., Lackey, Lower Jones
Fork, Knott Co., KY
Residence: Wheelwright, Ky.
Length of residence: (blank)
Female, White, Infant
Husband or Wife of: (blank)
Birth Date: (blank)
Age: 01 years, 05 months, 28 days
Occupation: (blank)
Place of Birth: Wheelwright, Ky.
Name of Father: Jimmie ELLIS
Birthplace Father: Prestonsburg, Ky.
Maiden Name of Mother: Pearl LEEMASTER
Birthplace Mother: White House, Kentucky
Informant: Bill ELLIS, Prestonsburg, Ky.
Death Date: 20 December 1936
Cause of Death: Patient swallowed lye. Three days later
developed Pneumonia.
Contributory: Swallowed lye. Pneumonia.
Mouth and Throat burned
Signed: W. L. Stumbo, Lackey, Ky.
Burial Place: B??? Creek
Date of Burial: 22 December 1936
Undertaker: G. D. Ryan, Martin, Ky.
File Date: 26 February 1937
Transcribed by Debbie Tamborski, 18 September 2009 |
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