|
DEATH
CERTIFICATE
MALISA CALDONIA NELSON
Date: 02 August 1953
Cert: 16938
Place of Death: County: Johnson City or Town:
Rural
Length of stay (in this place): (blank)
Street address or location: West Van Lear V. P.
Usual Residence of Deceased: State: Kentucky County:
Johnson
City or Town: Rural Street
Address: West Van Lear V. P.
Full Name: Malisa Caldonia NELSON
Date of Death: 02 August 1953
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth: 22 February 1878
Age: 75 years, 05 months, 10 days
Usual Occupation: Housewife
Kind of Industry or business: at home
Birthplace: Knott County, Kentucky
Father's Name: Clay MARTIN
Mother's Maiden Name: Nancy PRICE
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: J. W. NELSON
Disease or condition directly leading to death:
Pneumonia
Interval between onset and death: 03 days
Due to (b): Cerebral Hemorrhage
Interval between onset and death: 02 weeks
Due to (c): Arterio Sclerosis
Other significant conditions: (blank)
Date of Operation: (blank)
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 1952 to
02 August 1953, that I last saw the deceased alive on 01
August 1953, and
that death occurred at 3:35 p.m., from the causes and on the
date stated above.
Date signed: 03 August 1953
Address: Paintsville
Signature: Saul B. Hall, M.D.
Burial, Cremation or Removal: Burial
Date: 05 August 1953
Name of Cemetery or Crematory: Van Hoose Cemetery
Location: Paintsville, Kentucky
Date received by local registrar: 07 August 1953
Registrar's Signature: Freda Willoughby
Funeral director /address: Jones Funeral Home,
Paintsville, Ky.
Transcribed by Debbie Tamborski, 13 August 2010 |
|