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DEATH
CERTIFICATE
JAMES KITCHEN
Date: 27 June 1940
Cert: 17489
Place of Death: County: Knott City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: (illegible)
Full Name: James KITCHEN
If Veteran Name War: (blank)
Social Security No.: 403-09-4382
Sex, Color or Race, Marital Status: (illegible)
Husband or Wife of: (illegible) KITCHEN
Age of husband or wife if alive: 23 years
Birth date of deceased: 11 July 1913
Age: 26 years
Birthplace: Letcher Co.
Occupation: Labor
Industry or business: W.P.A.
Father Name: John KITCHEN
Father Birthplace: Carter Co.
Mother Maiden Name: Eva WATKINS
Mother Birthplace: Carter Co.
Informant/Address: John KITCHEN, Fed, Ky.
Burial Place: Hueysville, Ky.
Date: 29 June 1940
Signature of funeral director/address: W. J. Ryan, Martin
Date received by local registrar: 09 July 1940
Registrar's Signature: Macie Miller
Date of Death: 27 June 1940
I hereby certify that I attended deceased from (illegible) to
(illegible), that I last saw him alive on 27 June 1940, and that death
occurred on the date stated above at 2:50 p.m.
Immediate cause of death: Peritonitis
Duration: (blank)
Due to: Ruptured appendix
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: R. A. Thompson, M.D., Lackey,
Ky.
Date signed: 27 June 1940
Transcribed by Debbie Tamborski, 27 August 2010 |
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