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DEATH
CERTIFICATE
COBERN OWEN JR.
Date 08 July 1943
Cert: 21031
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Hazard Hospital Co.
Full Name: Cobern OWEN Jr.
If Veteran Name War: no
Social Security No.: none
Sex, Color or Race, Marital Status: Male, White, (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 07 July 1943
Age: 01 days
Birthplace: Hazard Hospital Co.
Occupation: Infant
Industry or business: (blank)
Father Name: Corbet OWEN
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Rosie M. RICHIE
Mother Birthplace: Knott Co., Ky.
Informant: Corbet OWEN, Richie, Ky.
Burial Place: Richie, Ky.
Date: 09 July 1943
Signature of funeral director: Maggard's, Hazard, Ky.
Date received by local registrar: 01 August 1943
Registrar's Signature: A. L. Boulos
Date of Death: 08 July 1943
I hereby certify that I attended deceased from 07 July 1943 to
08 July 1943, that I
last saw him alive on 08 July 1943, and that death occurred on the date
stated above at 6 p.m.
Immediate cause of death: (illegible) Heart Disease
Other Conditions: Club feet - (illegible)
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 20 July 1943
Transcribed by Debbie Tamborski, 06 February 2010 |
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