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DEATH
CERTIFICATE
ROSA NAPIER
Date: 01 August 1950
Cert: 17098
Place of Death: County: Perry City or Town:
Ary
Length of stay (in this place): 01
Name of Hospital or Institution: Homeplace Clinic Hosp.
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Ary Street Address: (blank)
Full Name: Rosa NAPIER
Date of Death: 01 August 1950
Sex, Color or Race, Marital Status: Female, White, Widowed
Date of Birth: 02 May 1873
Age: 77 years, 02 months, 30 days
Usual Occupation: House wife
Kind of Industry or business: Home
Birthplace: Knott Co., Ky.
Father's Name: Bill DOBSON
Mother's Maiden Name: Bess HAYES
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: A. J. SMITH
Disease/condition directly leading to death: Myocarditis
Chronic
Interval between onset and death: 02 years
Due to: (blank)
Other significant conditions: Edema
Interval between onset and death: 01 years
Major findings of operation: (blank)
Autopsy: no
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
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 21 February
1950 to
01 August 1950, that I last saw the deceased alive on 06 April
1950, and
that death occurred at (blank), from the causes and on the
date stated above.
Date signed: 09 August 1950
Address: Homplace, Ary, Ky.
Signature: Paul E. Adolph, M.D.
Burial, Cremation or Removal: Burial
Date: 02 August 1950
Name of Cemetery or Crematory: Holliday Cemetery
Location: Perry Co., Ky.
Date received by local registrar: 10 August 1950
Registrar's Signature: Georgia Pendleton
Funeral director & address: Engle's, Hazard, Ky.
Transcribed by Debbie Tamborski, 15 July 2010 |
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