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DEATH
CERTIFICATE
ANNA LEE GIBSON
Date 04 November 1942
Cert: 24713
Place of Death: County: Jefferson City or Town:
Louisville
Hospital or Institution: Children's Free Hospital
Length of stay in hospital or community: 49 days
Usual Residence of Deceased: State: Kentucky County: Harlan
City or Town: Chevrolet
Full Name: Anna Lee GIBSON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 17 September 1940
Age: 02 years
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Denver GIBSON
Father Birthplace: Knott Co.
Mother Maiden Name: Lena DIXON
Mother Birthplace: Knott Co.
Informant: Rec. Child. Free Hosp.
Removal Place: Knott Co., Ky.
Date: 04 November 1942
Signature of funeral director: L. D. Cunningham, Harlan, Ky.
Date received by local registrar: 05 November 1942
Registrar's Signature: N. N. Ferguson
Date of Death: 04 November 1942
I hereby certify that I attended deceased from 17 September
1942 to
04 November 1942, that I last saw her alive on 04 November
1942, and that death occurred on the date stated above at 1:30
p.m.
Immediate cause of death: Broncho pneumonia
Duration: 01 days
Other conditions: Cophageal lye stricture - strong
passed for dilitation 03 November 1942
Major findings of operations: Lye stricture by direct
esophagoscopic vision
Accident, suicide, or homicide: Accident - swallowed lye
Date of occurrence: 17 July 1942 (?) [sic]
Where did injury occur: Home
While at work: (blank)
Means of injury: (blank)
Signature & Address: Edward Carl Scott, MD, 226 E. Chestnut
Date signed: 04 November 1942
Transcribed by Debbie Tamborski, 25 May 2010 |
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