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DEATH
CERTIFICATE
FAE HACKER
Date 21 June 1941
Cert: 18407
Place of Death: County: Perry City or Town:
Hazard, Ky.
Name of Hospital or Institution: Hurst Snyder Hospital
Length of stay in hospital or community: 2 hrs.
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Fisty, Ky.
Full Name: Fae HACKER
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Single
Husband or Wife of: child
Age of husband or wife if alive: (blank)
Birth date of deceased: 21 June 1941
Age: 02 hrs.
Birthplace: Hazard, Ky.
Occupation: Infant
Industry or business: (blank)
Father Name: Earl HACKER
Father Birthplace: Clay County, Ky.
Mother Maiden Name: Hazel CHADWELL
Mother Birthplace: Clay County, Ky.
Informant: Earl HACKER, Fisty, Ky.
Burial Place: Fisty, Ky.
Date: 22 June 1941
Signature of funeral director: Norris, Hazard, Ky.
Date received by local registrar: 26 July 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 21 June 1941
I hereby certify that I attended deceased from 21 June 1941 to
21 June 1941, that I
last saw him alive on 21 June 1941, and that death occurred on the date
stated above at 9 a.m.
Immediate cause of death: Contracted pelvis of mother,
forceps delivery
Due to: (illegible) cranial hemorrhage at birth
Major findings of operations: (blank)
Accident, suicide, or homicide: no
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: J. C. Coldiron, M.D., Hazard, Ky.
Date signed: 27 June 1941
Transcribed by Debbie Tamborski, 01 February 2010 |
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