|
DEATH
CERTIFICATE
HERMAN KELLY
Date 07 September 1946
Cert: 20412
Place of Death: County: Perry Co. City or
Town: Hazard, Ky.
Name of Hospital or Institution: Hazard Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Anco, Ky.
Full Name: Herman KELLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Maggie KELLY
Age of husband or wife if alive: 24 years
Birth date of deceased: 25 April 1915
Age: 21 years, 04 months, 12 days
Birthplace: Knott Co.
Occupation: Miner
Industry or business: (blank)
Father Name: A. J. KELLY
Father Birthplace: Knott Co.
Mother Maiden Name: Arzona MESSER
Mother Birthplace: Knott Co.
Informant: Maggie KELLY, Anco, Ky.
Burial Place: Corda, Ky. [sic]
Date: 08 September 1946
Signature funeral director: Maggard & Blair
Funeral Home, Hazard, Ky.
Date received by local registrar: 01 October 1946
Registrar's Signature: Opsie J. Deaton
Date of Death: 07 September 1946
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 (blank)
Immediate cause of death: Septic (illegilbe may be
--sore throat)
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: A. B. Morgan, Hazard, Ky.
Date signed: 12 September 1946
Transcribed by Debbie Tamborski, 10 February 2010 |
|