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DEATH
CERTIFICATE
THOMAS EVERSOLE
Date 30 October 1944
Cert: 28206
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Smithsboro
Full Name: Thomas EVERSOLE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Jemima EVERSOLE
Age of husband or wife if alive: 51
Birth date of deceased: 12 March
Age: 54 years
Birthplace: Perry Co.
Occupation: Substation work
Industry or business: Coal Co.
Father Name: James EVERSOLE
Father Birthplace: Kentucky
Mother Maiden Name: Martha VANOVER
Mother Birthplace: Kentucky
Informant: Mollie DAVIS, Smithsboro, Ky.
Burial Place: (blank)
Date: 01 November 1944
Signature of funeral director: Engle, Hazard, Ky.
Date received by local registrar: 13 December 1944
Registrar's Signature: Anna L. Boulos
Date of Death: 30 October 1944
I hereby certify that I attended deceased from 26 October 1944 to
30 October 1944, that I
last saw him alive on 30 October 1944, and that death occurred
on the date stated above at 12:40 a.m.
Immediate cause of death: diffuse peritonitis
Due to: Ruptured appendix
Major findings of operations: above
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. Jackson, M.D., Hazard, Ky.
Date signed: 16 November 1944
Transcribed by Debbie Tamborski, 07 February 2010 |
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