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DEATH
CERTIFICATE
WILEY JENT
Date 28 June 1942
Cert: 07366
Place of Death: County: Perry City or Town:
Cody
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Cody
Full Name: WILEY JENT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 60 years
Birthplace: (blank)
Occupation: Farming
Industry or business: (blank)
Father Name: (blank)
Father Birthplace: (blank)
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: (blank)
Burial Place: (blank)
Date: (blank)
Signature of funeral director: Do not know
Date received by local registrar: (blank)
Registrar's Signature: Anna (illegible)
Date of Death: 28 June 1942
I hereby certify that I attended deceased from 28 June 1942 to
(blank), that I
last saw him alive on (blank), and that death occurred on the date
stated above at 11:30 p.m.
Immediate cause of death: Diffuse peritonitis
Due to: Ruptured gastric ulcer
Major findings of operations: Ruptured gastric ulcer
(illegible)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 07 July 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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