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DEATH
CERTIFICATE
BERNARD WAYNE MELAND
Date: 23 November 1940
Cert: 22641
Place of Death: County: Knott City or Town:
Hindman, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Ivis, Ky.
Full Name: Bernard Wayne MELAND
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 06 months, 17 days
Birthplace: Allegan, Mich.
Occupation: (blank)
Industry or business: (blank)
Father Name: Harold W. MELAND
Father Birthplace: Chicago, Ill.
Mother Maiden Name: Mildred BOSFIELD
Mother Birthplace: Allegan, Mich.
Informant/Address: Harold W. MELAND, Ivis, Ky.
Burial Place: Emmalena, Ky.
Date: 25 November 1940
Signature of funeral director/address: (blank), Hazard, Ky.
Date received by local registrar: 11 September 1941
Registrar's Signature: Phena Slone
Date of Death: 23 November 1940
I hereby certify that I attended deceased from 23 November
1940 to
23 November 1940, that I last saw him alive on 23 November
1940, and that death occurred on the date stated above at 3
p.m.
Immediate cause of death: Convulisons [sic] and Lobar pneumonia
Duration: (blank)
Due to: (blank)
Major findings of operations: none Of
autopsy: none
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: M. F. Kelley, M.D., Hindman
Date signed: 27 December 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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