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DEATH
CERTIFICATE
MANFORD KELLEY
Date 09 January 1924
Cert: 01898
Place of Death: Voting Precinct: Berea 16, Madison Co.,
Ky.
Full Name: Manford KELLEY
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 14 January 1907
Age: 16 years, 11 months, 26 days
Occupation: Student, Foundation Dept., Berea College
Birthplace: Knott Co., Kentucky
Name of Father: John R. KELLEY
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Nancy Ann SMITH
Birthplace Mother: Knott Co., Ky.
Informant/Address: George KELLEY, Elic, Ky.
Filed: 10 January 1924
Registrar: Jno Deur
Death Date: 09 January 1924
I hereby certify that I attended deceased from 04 January 1924, to
09 January 1924, that I last saw him alive on 09 January 1924,
and that death occurred, on the date stated above, at 8:55
p.m.
Cause of Death: General peritonitis following rupture of
appendix
Duration: 06 days
Contributory: (illegible) measles
Duration: 06 days
Signed/Address: R. H. Cowley, M.D., 10
January 1924, Berea, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Elic, Ky.
Date of Burial: 12 January 1924
Undertaker/Address: R. H. Chrisman, Berea, Ky.
Transcribed by Debbie Tamborski, 20 March 2010 |
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