Date: 30 September 1948
Cert: 21275
Place of Death: County: Knott City or
Town: Lackey
Name of Hospital or Institution: Stumbo Mem.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: Wayland
Full Name: Arnold MARTIN
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: 03 September 1948
Age: 27 days
Birthplace: Lackey, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Marian MARTIN
Father Birthplace: Wayland, Ky.
Mother Maiden Name: Thelma TERRY
Mother Birthplace: Wayland, Ky.
Informant: Marian MARTIN, Wayland, Ky.
Burial Place: Wayland, Ky.
Date: 01 October 1948
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 15 October 1948
Registrar's Signature: Rose B. Craft
Date of Death: 30 September 1948
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Toxemia
Duration: (blank)
Due to: Infectious Diarrhea
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: C. M. Aker, M.D., Lackey, Ky.
Date signed: 13 October 1948
Transcribed by Debbie Tamborski, 27 December 2010 |