Date: 23 January 1953
Cert: 03529
Place of Death: County: Knott
City or Town: Cody
Length of stay (in this place): (blank)
Street address or location: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Cody If rural give
location:
(blank)
Full Name: Jasper HALE
Date of Death: 23 January 1953
Sex, Color or Race, Marital Status: Male, White, Widowed
Date of Birth: 09 November 1867
Age: 85 years
Usual Occupation: (blank)
Kind of Industry or business: Farmer
Birthplace: Knott Co., Ky.
Father's Name: John HALE
Mother's Maiden Name: BREEDING
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Cleo HALE
Disease or condition directly leading to death: Cerebral
Apoplexy
Interval between onset and death: 03 days
Due to (b): Hypertension
Due to (c): Senility
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
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 20 January 1953 to
23 January 1953, that I last saw the deceased alive on 22
January 1953, and
that death occurred at 10:00 a.m., from the causes and on the
date stated above.
Date signed: 20 February 1953
Address: Allock
Signature: A. B. Pigman, M.D.
Burial, Cremation or Removal: Burial
Date: 25 January 1953
Name of Cemetery or Crematory: Carr Creek School Cemetery
Location: Carr Creek, Ky.
Date received by local registrar: 26 February 1953
Registrar's Signature: Rose B. Craft
Funeral director & address: John Everage
Transcribed by Debbie Tamborski, 07 February 2011 |