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DEATH
CERTIFICATE
LAN MESSER
Date 29 September 1950
Cert: 21481
Place of Death: County: Perry City or Town: Ary Rural
Length of stay in hospital or community: 01 day
Name of Hospital or Institution: Homeplace Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Rural Location:
Carrie, Ky.
Full Name: Lan MESSER
Date of Death: 29 September 1950
Sex, Color or Race, Marital Status: Male, White, Never married
Date of Birth: 26 November 1947
Age: 01 years, 08 months
Usual Occupation: None
Kind of Industry or business: None
Birthplace: Knott Co.
Father's Name: Carue MESSER
Mother's Maiden Name: Cherry SHORT
Was deceased in ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Carue MESSER
Disease/condition directly leading to death: Shock and
(illegible)
Interval between onset and death: (blank)
Due to: 2 & 3rd burns over 65% body surface scalding
with boiling water (accidental)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings for operation: (blank)
Accident, suicide, or homicide: Accident
Place of injury: home
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 28 September
1950 to 29 September 1950, that I
last saw the deceased alive on 29 September 1950, and that death occurred on
the date stated above at 9:30, from the causes and on the date
stated above.
Date signed: 05 October 1950
Address: Homeplace Hospital, Ary, Ky.
Signature: Clarence F. (illegible) M.D.
Burial, Cremation or Removal: Burial
Date: 01 October 1950
Name of Cemetery or Creamatory: Family Cemetery
Location: Carrie, Ky.
Date received by local registrar: 17 October 1950
Registrar's Signature: Georgia Pendleton
Funeral director and address: J. N. Toul, Director,
Hindman Funeral Home
Transcribed by Debbie Tamborski, 16 February 2010 |
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