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DEATH
CERTIFICATE
DONALD RAY EVERIDGE
Date 18 August 1941
Cert: 20822
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Hindman
Full Name: Donald Ray EVERIDGE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 02 February 1941
Age: 06 months
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Edwin EVERIDGE
Father Birthplace: Ind.
Mother Maiden Name: Edna AMBURGEY
Mother Birthplace: Hindman, Ky.
Informant: Edwin EVERIDGE, Hindman, Ky.
Burial Place: Hindman
Date: 19 August 1941
Signature of funeral director: Engle, Hazard, Ky.
Date received by local registrar: 19 August 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 18 August 1941
I hereby certify that I attended deceased from 18 August 1941 to
18 August 1941, that I
last saw him alive on (blank), and that death occurred on the date
stated above at 5:30 p.m.
Immediate cause of death: Meningitis
Due to: (blank)
Major findings of operations: No
Accident, suicide, or homicide: No
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: R. L. Collins, M.D., Hazard, Ky.
Date signed: 19 August 1941
Transcribed by Debbie Tamborski, 01 February 2010 |
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