|
DEATH
CERTIFICATE
Mrs. NANCY SMITH KELLY
Date 05 September 1944
Cert: 19855
Place of Death: County: Fayette City or
Town: Lexington
Name of Hospital or Institution: 817 West High St.
Length of stay in hospital or community: 07 days
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Cordia
Full Name: Mrs. Nancy SMITH KELLY
If Veteran Name War: (blank)
Social Security No.: None
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: John Riley KELLY
Age of husband or wife if alive: (blank)
Birth date of deceased: 25 February 1878
Age: 66 years, 06 months, 10 days
Birthplace: Cordia, Ky.
Occupation: At home
Industry or business: (blank)
Father Name: Jerry SMITH
Father Birthplace: Ky.
Mother Maiden Name: Polly COLLINS
Mother Birthplace: Ky.
Informant: Mrs. Manotee RALEY, 817 West High St.
Burial Place: Cordia, Ky.
Date: 07 September 1944
Signature of funeral director: W. R. Milward, Lexington, Ky.
Date received by local registrar: 07 September 1944
Registrar's Signature: D. A. Lemlex
Date of Death: 05 September 1944
I hereby certify that I attended deceased from 03 September
1944 to 05 September 1944, that I
last saw him alive on 03 September 1944, and that death occurred on the date
stated above at 5:20 a.m.
Immediate cause of death: (blank)
Due to: apoplexy
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: Thomas A. Shannon, M.D., 822 W. High St.
Date signed: 05 September 1944
Transcribed by Debbie Tamborski, 08 February 2010 |
|