Date: 03 December 1956
Cert: #56-25982
Place of Death: County: Knott
City or Town: Cordia - Rural
Length of stay (in this place): none
Full Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Cordia Residence
on a Farm?: Yes
Street Address: (blank) Residence inside
City Limits?: No
Full Name: John Riley KELLY
Date of Death: 03 December 1956
Sex, Color or Race, Marital Status: Male, White, Widowed
Date of Birth: 08 December 1878
Age: 78 years
Usual Occupation: Retired Lumberman
Kind of Industry or business: none
Birthplace: Lotts Creek, Knott Co., Ky.
Father's Name: William KELLY
Mother's Maiden Name: Sally YOUNG
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: Mrs. M. F. Kelly (Sister-in-law)
Disease/condition directly leading to death: Cancer
of Stomach
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Describe how injury occurred: (blank)
Time of injury: (blank)
Injury occurred at work: (blank)
Place of injury: (blank)
City, Town or Location, County, State: Hindman, Knott, Ky.
I hereby certify that I attended deceased from 15 January 1955 to
03 December 1956, that I last saw the deceased alive on 03
December 1956, and
that death occurred at 10:50 a.m., from the causes and on the
date stated above.
Date signed: 04 December 1956
Address: Hindman, Ky.
Signature: M. F. Kelly, M.D.
Burial, Cremation or Removal: Burial
Date: 05 December 1956
Name of Cemetery or Crematory: Kelly Cemetery
Location: Lotts Creek, Cordia, Knott Co., Ky.
Date received by local registrar: 07 December 1956
Registrar's Signature: Myrtle Slone
Funeral director & address: Maggard Funeral Home,
Hazard, Kentucky
Transcribed by Debbie Tamborski, 25 April 2012 |