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DEATH
CERTIFICATE
ROBERT JAKES
Date 20 June 1945
Cert: 12109
Place of Death: County: Fayette City or
Town: Lexington
Name of Hospital or Institution: Eastern State Hospital
Length of stay in hospital or community: 00 yrs, 04 mos,
20 days
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Litt Carr
Full Name: Robert JAKES
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widower
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 67 years
Birthplace: Dayton, Tennessee
Occupation: Coal miner
Industry or business: (blank)
Father Name: Unknown
Father Birthplace: (blank)
Mother Maiden Name: Unknown
Mother Birthplace: (blank)
Informant: Hospital Records, Lexington, Kentucky
Burial Place: Pike Co., Ky.
Date: 1945
Signature funeral director: Lowe F. Home by
Merritt Martin, Lex., Ky.
Date received by local registrar: 26 June 1945
Registrar's Signature: D. A. Furlong
Date of Death: 20 June 1945
I hereby certify that I attended deceased from 30 January 1945 to
20 June 1945, that I
last saw him alive on 20 June 1945, and that death occurred on the date
stated above at 5:05 a.m.
Immediate cause of death: General Arteriosclerosis
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: W. (illegible), M.D., Eastern
State Hosp., Lexington, Ky.
Date signed: 20 June 1945
Transcribed by Debbie Tamborski, 09 February 2010 |
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