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DEATH
CERTIFICATE
JACKSON KELLY
Date 18 March 1944
Cert: 21176
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Anco
Full Name: Jackson KELLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 50 years
Birthplace: Knott Co., Ky.
Occupation: Electrical Repair Man
Industry or business: (blank)
Father Name: William KELLY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Maggie OWENS
Mother Birthplace: Scott Co., Virginia
Informant: Anna G. TOLLIVER, Anco, Ky.
Burial Place: Cordia, Ky.
Date: 21 March 1944
Signature funeral director: Maggard Funeral Home, Hazard, Ky.
Date received by local registrar: 05 August 1944
Registrar's Signature: Anna L. Boulos
Date of Death: 18 March 1944
I hereby certify that I attended deceased from 15 March 1944 to
18 March 1944, that I
last saw him alive on 18 March 1944, and that death occurred on the date
stated above at 3 a.m.
Immediate cause of death: Bronchial pneumonia
Other conditions: Septic pharyngitis & dehydration &
septicemia
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 20 March 1944
Transcribed by Debbie Tamborski, 08 February 2010 |
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