Date: 30 May 1947
Cert: 16056
Place of Death: County: Knott
City or
Town: Ambergy, Ky. Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Ambergy, Ky. Rural
Full Name: Kirby KELLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Child
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 24 March 1947
Age: 02 months, 06 days
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Benett KELLY
Father Birthplace: Knott Co.
Mother Maiden Name: Eliza HALL
Mother Birthplace: Knott Co.
Informant: Bennett KELLY, Amburgey
Burial Place: Ambergy
Date: 30 May 1947
Signature of funeral director: Maggard & Blair F. H.,
(illegible), Hazard, Ky.
Date received by local registrar: 30 July 1947
Registrar's Signature: Rose B. Craft
Date of Death: 30 May 1947
I hereby certify that I attended deceased from 29 May 1947 to
30 May 1947, that I last saw him alive on 29 May 1947, and
that death occurred on the date stated above at 5 a.m.
Immediate cause of death: Intestinal obstruction
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: A. B. Pigman, M.D., Allock
Date signed: 27 June 1947
Transcribed by Debbie Tamborski, 18 December 2010 |