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DEATH
CERTIFICATE
WILLIAM EVERAGE
Date 17 June 1953
Cert: 11904
Place of Death: County: Fayette City or Town: Lexington
Length of stay in hospital or community:
Name of Hospital or Institution: Good Samaritan
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Tina
Full Name: William EVERAGE
Date of Death: 17 June 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 21 August 1921
Age: 32 years
Usual Occupation: Lumber
Kind of Industry or business: Logging
Birthplace: Kentucky
Father's Name: Jake EVERAGE
Mother's Maiden Name: Dorie POLLY
Was deceased ever in armed forces: Yes
Social Security No.: (blank)
Informant: Hospital records
Disease or condition directly leading to death: Cerebral
damage due to prolonged hypoxia with respiratory failure
Interval between onset and death: 04 days
Due to (b): Profound shock
Interval between onset and death: 04 days
Due to (c): Multiple fractures of pelvis & transection
of urethra
Interval between onset and death: 04 days
Other significant conditions: (blank)
Date of Operation: 13 June 1953
Major findings of operation: Multiple fractures of pelvis,
transection of urethra (illegible) & laceration sigmoid colon
Accident, suicide, or homicide: accident
Place of injury: lumber mill
City or Town, County, State: Ball Branch (Perry), Ky.
Time of Injury: 12 June 1953 11:50 a.m.
Injury occurred at work: While at work
How did injury occur: Tree fell on lower abdomen & pelvis
I hereby certify that I attended deceased from 13 June 1953 to
17 June 1953, that I last saw the deceased alive on 16 June
1953, and that death occurred on the date stated above at 3:10
a.m., from the causes and on the date stated above.
Date signed: 25 June 1953
Address: 203 W. 2nd St., Lexington, Ky.
Signature: M. Randolph Jillian, M.D.
Burial, Cremation or Removal: Burial
Date: 19 June 1953
Name of Cemetery or Creamatory: Wooten Cemetery
Location: Bearville, Ky.
Date received by local registrar: 26 June 1953
Registrar's Signature: D. A. Furlong
Funeral director and address: John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 21 February 2010 |
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