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DEATH
CERTIFICATE
TOM KELLEY
Date: 05 June 1948
Cert: 13181
Place of Death: County: Perry
City or Town: Hazard
Street No. or Location: Home
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Hazard, Ky.
Full Name: Tom KELLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Mable KELLEY
Age of husband or wife if alive: 52 years
Birth date of deceased: 27 February 1889
Age: 59 years, 03 months, 08 days
Birthplace: Knott Co.
Occupation: Railroad
Industry or business: (blank)
Father Name: Dr. E. KELLEY
Father Birthplace: Knott Co.
Mother Maiden Name: Matty PETERY
Mother Birthplace: Perry
Informant: Lois KELLEY, Hazard, Ky.
Burial Place: Englewood (Perry)
Date: 06 June 1948
Signature of funeral director: Engle's, Hazard, Ky.
Date received by local registrar: 10 June
1948
Registrar's Signature: Helen C. Buriss
Date of Death: 05 June 1948
I hereby certify that I attended deceased from September 1947 to
05 June 1948, that I last saw him alive on 05 June 1948, and
that death occurred on the date stated above at 2:30 a.m.
Immediate cause of death: Secondary anemia
Duration: (illegible) Congestive ht. failure
Duration: 03 months
Due to: Cancer of urinary bladder
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: Martin Palmer,
Hazard, Ky.
Date signed: 08 June 1948
Transcribed by Debbie Tamborski, 01 July 2010 |
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