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DEATH
CERTIFICATE
JOHN D. KELLY
Date 11 October 1942
Cert: 27830
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: John D. KELLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Martha KELLY
Age of husband or wife if alive: 40 years
Birth date of deceased: 14 July 1890
Age: 54 years
Birthplace: Knott Co., Ky.
Occupation: Merchant
Industry or business: (blank)
Father Name: John KELLY
Father Birthplace: Ky.
Mother Maiden Name: Sarah HAMMOND
Mother Birthplace: Wolfe Co., Ky.
Informant: Martha KELLY, Anco
Burial Place: Anco
Date: 12 October 1942
Signature of funeral director: Engles, Hazard, Ky.
Date received by local registrar: 31 December 1942
Registrar's Signature: Anna (illegible)
Date of Death: 11 October 1942
I hereby certify that I attended deceased from 08 October 1942 to
11 October 1942, that I
last saw him alive on 11 October 1942, and that death occurred on the date
stated above at 11:10 a.m.
Immediate cause of death: Pneumonia - type
?(transcribed as written)
Due to: Typhoid fever
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: 22 October 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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