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DEATH
CERTIFICATE
DARLENE JOHNSON
Date 06 May 1949
Cert: 10192
Place of Death: County: Letcher City or Town:
Fleming
Length of stay in hospital or community: 01 day
Name of Hospital or Institution: Fleming Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Puncheon, Knott County
Full Name: Darlene JOHNSON
Date of Death: 06 May 1949
Sex, Color or Race, Marital Status: Female, White, Single
Date of Birth: ? (20 months old) (transcribed as
written)
Age: 01 years, 08 months
Usual Occupation: none
Kind of Industry or business: none
Birthplace: Knott Co., Ky.
Father's Name: Raymond JOHNSON
Mother's Maiden Name: -------THORNSBURY
Was deceased in ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Fleming Hospital Staff
Disease or condition directly leading to death:
Poliomyelitis ?
Interval between onset and death: 04 days
Due to: (Bulbar Type)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings for operation: (by investigation)
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 (blank) to
(blank), that I last saw the deceased alive on (blank), and
that death occurred on the date stated above at 5 p.m., from
the causes and on the date stated above.
Date signed: 07 May 1949
Address: Whitesburg, Ky.
Signature: R. D. Collins, M.D.
Burial, Cremation or Removal: Burial
Date: 08 May 1949
Name of Cemetery or Creamatory: Family Cem.
Location: Puncheon, Ky.
Date received by local registrar: 18 May 1949
Registrar's Signature: E. M. Collins
Funeral director and address: Family, Puncheon, Ky.
Transcribed by Debbie Tamborski, 15 February 2010 |
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