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DEATH
CERTIFICATE
CARLES HALL
Date: 22 June 1949
Cert: 12244
Place of Death: County: Johnson City or Town:
Paintsville
Length of stay (in this place): (blank)
Name of Hospital or Institution: Paintsville Hospital
Usual Residence of Deceased: State: Ky. County:
Johnson
City or Town: Rural Street
Address: Staffordsville V.P.
Full Name: Carles HALL
Date of Death: 22 June 1949
Sex, Color or Race, Marital Status: Male, White, Infant
Date of Birth: 05 November 1948
Age: 07 months, 17 days
Usual Occupation: (blank)
Kind of Industry or business: (blank)
Birthplace: Knott Co., Ky.
Father's Name: Gleva HALL
Mother's Maiden Name: Marry HENSON
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Gleva HALL
Disease/condition directly leading to death: Bacillary
Dysentery
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (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 22 June 1949 to
22 June 1949, that I last saw the deceased alive on 22 June
1949, and
that death occurred at 4 p.m., from the causes and on the
date stated above.
Date signed: 22 June 1949
Address: Paintsville, Ky.
Signature: Lon C. Hall, M.D.
Burial, Cremation or Removal: Burial
Date: 24 June 1949
Name of Cemetery or Crematory: Roaring Branch Cem.
Location: Top Most, Knott Co., Ky.
Date received by local registrar: 23 June 1949
Registrar's Signature: Madge Salyer
Funeral director & address: Jones Funeral Home,
Paintsville, Ky.
Transcribed by Debbie Tamborski, 12 July 2010 |
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