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DEATH
CERTIFICATE
ARAZONIA KELLEY
Date 10 June 1940
Cert: 15657
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hosp. High W. St.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural Street No.:
Knott Co.
Full Name: Arazonia KELLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: A. J. KELLEY
Age of husband or wife if alive: 61 years
Birth date of deceased: ? January 1900 [sic]
Age: 40 years
Birthplace: Knott Co., Ky.
Occupation: House wf.
Industry or business: (blank)
Father Name: E. R. MESSER
Father Birthplace: Round Co., Ky.
Mother Maiden Name: Sussie FUGATE
Mother Birthplace: Knott Co., Ky.
Informant: E. R. MESSER, Anco, Ky.
Burial Place: Anco, Ky.
Date: 12 June 1940
Signature of funeral director: Ray Engle, Hazard, Ky.
Date received by local registrar: 01 July 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 10 June 1940
I hereby certify that I attended deceased from 10 June 1940 to
10 June 1940, that I last saw h-- alive on 10 June 1940, and
that death occurred on the date stated above at 10 p.m.
Immediate cause of death: Peritonitis
Duration: (blank)
Due to: (illegible) ruptured Uterus
Major findings of operations/autopsy: None
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. E. Hagan, M.D., Hazard, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 10 May 2010 |
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