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DEATH
CERTIFICATE
Mrs. TOM JONES
Date 06 December 1942
Cert: 02291
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: 2 days
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Fisty Rural
Full Name: Mrs. Tom JONES
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Tom JONES
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 21 years
Birthplace: Knott Co., Ky.
Occupation: Housewife
Industry or business: (blank)
Father Name: Alex FRANCIS
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Sarilda SMITH
Mother Birthplace: Knott Co., Ky.
Informant: Tom JONES, Fisty
Burial Place: Fisty
Date: 07 December 1942
Signature funeral director: Engle Und. & Hdw. Co.,
Hazard, Ky.
Date received by local registrar: 01 January 1943
Registrar's Signature: Anna (illegible)
Date of Death: 06 December 1942
I hereby certify that I attended deceased from 04 December
1942 to 06 December 1942, that I
last saw her alive on 05 December 1942, and that death occurred on the date
stated above at 4:50 a.m.
Immediate cause of death: (blank)
Due to: 1st & 2nd degree burns to body.
(illegible) epilepsy
Other conditions: Epilepsy
Accident, suicide, or homicide: Accident
Date of occurrence: 04 December 1942
Where did injury occur: fell in open grate
While at work: Housework
Means of injury: (blank)
Signature: Chris S. Jackson, Hazard, Ky.
Date signed: 19 December 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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