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DEATH
CERTIFICATE
G. W. KELLY
Date: 21 September 1947
Cert: 25161
Place of Death: County: Perry City or Town:
Hazard, Ky.
Hospital or Institution: none
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Hazard, Ky.
Full Name: G. W. KELLY
If Veteran Name War: none
Social Security No.: none
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: Deceased
Age of husband or wife if alive: (blank)
Birth date of deceased: 13 March 1866
Age: 81 years, 06 months, 08 days
Birthplace: Knott County, Ky.
Occupation: Merchant & Teacher
Industry or business: Store
Father Name: G. W. KELLY
Father Birthplace: Knott County, Ky.
Mother Maiden Name: Sarah SMITH
Mother Birthplace: Knott County, Ky.
Informant: (blank)
Burial Place: Smithboro, Ky.
Date: 22 September 1947
Signature funeral director: Maggard-Blair & Garrett, Hazard,
Ky.
Date received by local registrar: 01 October 1947
Registrar's Signature: Cleata D. Cox
Date of Death: 21 September 1947
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 7:30 a.m.
Immediate cause of death: Cerebral Hemorrhage
Duration: (blank)
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: C. L. Combs, Hazard, Ky.
Date signed: 26 September 1947
Transcribed by Debbie Tamborski, 23 June 2010 |
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