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DEATH
CERTIFICATE
EVERETT MCDOWELL
Date 11 January 1943
Cert: 00710
Place of Death: County: Fayette City or
Town: Lexington
Name of Hospital or Institution: Eastern State Hospital
Length of stay in hospital or community: 01 months, 24
days
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Mousie
Full Name: Everett MCDOWELL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Versie MCDOWELL
Age of husband or wife if alive: 38 years
Birth date of deceased: (blank)
Age: 40 years
Birthplace: Leon, Ky.
Occupation: Mechanic
Industry or business: (blank)
Father Name: Deceased
Father Birthplace: (blank)
Mother Maiden Name: Deceased
Mother Birthplace: (blank)
Informant: Hospital Records, Lexington, Kentucky
Burial Place: Prestonsburg, Ky.
Date: 13 January 1943
Signature of funeral director: E. P. Arnold,
Prestonsburg, Ky.
Date received by local registrar: 23 January 1943
Registrar's Signature: D. A. Furlong
Date of Death: 11 January 1943
I hereby certify that I attended deceased from 17 November
1942 to 11 January 1943, that I
last saw him alive on 10 January 1943, and that death occurred on the date
stated above at 6:05 a.m.
Immediate cause of death: Cerebro - Spinal Syphilis
Due to: (blank)
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: Edythe A. Bacon, M.D., Lexington, Ky., Eastern
State Hospital
Date signed: 11 January 1943
Transcribed by Debbie Tamborski, 06 February 2010 |
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