Date: 27 April 1946
Cert: 11621
Place of Death: County: Knott City or
Town: Rural - Dema, Ky.
Name of Hospital or Institution: at own home - Dema, Ky.
Length of stay in hospital or community: 01 day
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Rural
Full Name: Farrel Dean LAYNE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White,
Single
Husband or Wife of: None
Age of husband or wife if alive: (blank)
Birth date of deceased: 27 April 1946
Age: 12 hours
Birthplace: Dema, Ky., Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Oakley LAYNE
Father Birthplace: Dema, Ky., Knott Co.
Mother Maiden Name: Evelyn MORRIS
Mother Birthplace: Eastern, Ky., Floyd Co.
Informant: Mark DEMPSEY, M.D., Garrett, Ky.
Burial Place: Dema, Ky.
Date: 28 April 1946
Signature of funeral director: None - Friends, Dema, Ky.
Date received by local registrar: 10 May 1946
Registrar's Signature: Mrs. Rose B. Craft
Date of Death: 27 April 1946
I hereby certify that I attended deceased from 27 April 1946 to
27 April 1946, that I last saw him alive on 27 April 1946, and
that death occurred on the date stated above at 4 p.m.
Immediate cause of death: weakness from mother having
Flue
Duration: 04 months
Due to: (blank)
Other conditions: Mother had Flue
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Mark Dempsey, M.D., Garrett
Date signed: 08 May 1946
Transcribed by Debbie Tamborski, 08 December 2010 |