Date: 28 December 1946
Cert: 16055
Place of Death: County: Knott City or
Town: Wisco, Ky.
Name of Hospital or Institution: At Home
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Perry
City or Town: Wisco, Ky.
Full Name: Paula Roene KEITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 06 November 1946
Age: 02 months, 25 days
Birthplace: Wisco, Ky.
Occupation: None
Industry or business: (blank)
Father Name: L. KEITH
Father Birthplace: Jackson, Ky.
Mother Maiden Name: Gladis MULLINS
Mother Birthplace: Perry
Informant: (blank)
Burial Place: Lothair, Ky.
Date: 29 December 1946
Signature funeral director: Maggard & Blair F. H., Hazard, Ky.
Date received by local registrar: 30 July 1947
Registrar's Signature: Rose B. Craft
Date of Death: 28 December 1946
I hereby certify that I attended deceased from 20 December
1946 to
27 December 1946, that I last saw him alive on 24 December
1946, and that death occurred on the date stated above at 4
a.m.
Immediate cause of death: Bronchial pneumonia
Duration: 10 days
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 & Address: A. B. Pigman, M.D., Allock
Date signed: 28 December 1946
Transcribed by Debbie Tamborski, 08 December 2010 |