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DEATH
CERTIFICATE
DOSS LANE
Date 01 December 1953
Cert: 27441
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community: (blank)
Name of Hospital or Institution: Mount Mary Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Rural Street Address:
(illegible)
Full Name: Doss LANE
Date of Death: 01 December 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 22 March 1901
Age: 52 years
Usual Occupation: Farmer
Kind of Industry or business: Farming
Birthplace: Tennessee
Father's Name: James LANE
Mother's Maiden Name: Rachel NISLEY
Was deceased ever in armed forces: No
Social Security No.: None
Informant: Mrs. Doss LANE
Disease/condition directly leading to death: Acute Heart
Failure
Interval between onset and death: (blank)
Due to: Acute indigestion
Interval between onset and death: 08 hours
Date of Operation: (blank)
Major findings of operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 01 December
1953 to 01 December 1953, that I
last saw the deceased alive on 01 December 1953, and that death occurred on
the date stated above at 7 a.m., from the causes and on the date
stated above.
Date signed: 08 December 1953
Address: Allock, Ky.
Signature: A. B. Pigman, M.D.
Burial, Cremation or Removal: Burial
Date: 03 December 1953
Name of Cemetery or Creamatory: Kelly Cemetery
Location: Smithsboro, Knott Co., Ky.
Date received by local registrar: 08 December 1958
Registrar's Signature: J. F. Blackerby, State Reg. by L.
B.
Funeral director and address: John N. Taul, Hindman, Ky.
Transcribed by Debbie Tamborski, 21 February 2010 |
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