Date: 15 July 1941
Cert: 20354
Place of Death: County: Knott City or
Town: Lackey
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: Garrett
Full Name: Charles MABES, Jr.
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 11 March 1941
Age: 04 months, 11 days
Birthplace: Garrett, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Raymond MABES
Father Birthplace: Knox Co., Ky.
Mother Maiden Name: Mabel PRESSLY
Mother Birthplace: Grundy, Va.
Informant: Raymond MABES, Garrett, Ky.
Burial Place: Garrett
Date: 17 July 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar: 15 August 1941
Registrar's Signature: Phena Slone
Date of Death: 15 July 1941
I hereby certify that I attended deceased from 15 July 1941 to
15 July 1941, that I last saw him alive on 15 July 1941, and
that death occurred on the date stated above at 11:00 p.m.
Immediate cause of death: Bronchopneumonia
Duration: 02 days
Due to: (blank)
Other conditions: non specific diarrhea
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: C. R. Messer, M.D., Lackey
Date signed: 24 July 1941
Transcribed by Debbie Tamborski, 14 October 2010 |