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DEATH
CERTIFICATE
LITTLE FIELDS
Date 16 June 1953
Cert: 19448
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community: (blank)
Name of Hospital or Institution: Mount Mary Hospital
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Smithsboro
Full Name: Little FIELDS
Date of Death: 16 June 1953
Sex, Color or Race, Marital Status: Male, White, Never married
Date of Birth: 15 June 1953
Age: 15 hours, 15 min.
Usual Occupation: (blank)
Kind of Industry or business: (blank)
Birthplace: Hazard, Ky.
Father's Name: Green FIELDS
Mother's Maiden Name: Florence FIELDS
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Florence FIELDS
Disease or condition directly leading to death:
atelectasis
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 15 June 1953 to
16 June 1953, that I
last saw the deceased alive on 15 June 1953, and that death occurred on
the date stated above at 12:05 a.m., from the causes and on the date
stated above.
Date signed: 16 June 1953
Address: Hazard, Ky.
Signature: W. O'Donnell, M.D.
Burial, Cremation or Removal: Removal
Date: 17 June 1953
Name of Cemetery or Creamatory: Fields Cemetery
Location: Carcassonne, Ky.
Date received by local registrar: 06 August 1953
Registrar's Signature: Georgia P. Surer
Funeral director and address: None
Transcribed by Debbie Tamborski, 21 February 2010 |
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