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DEATH
CERTIFICATE
ANN LUE OWENS
Date 24 April 1943
Cert: 12228
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural Fisty
Full Name: Ann Lue OWENS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 03 January 1937
Age: 06 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Arnold OWENS
Father Birthplace: Knott Co.
Mother Maiden Name: Hazle CAMPBELL
Mother Birthplace: Knott Co.
Informant: Arnold OWENS, Fisty
Burial Place: Fisty
Date: 25 April 1943
Signature funeral director: Engle Und. & Hdw. Co., Hazard, Ky.
Date received by local registrar: 31 May 1943
Registrar's Signature: Anna Laura Boulos
Date of Death: 24 April 1943
I hereby certify that I attended deceased from 22 April 1943 to
24 April 1943, that I
last saw him alive on 24 April 1943, and that death occurred on the date
stated above at 11 a.m.
Immediate cause of death: 2 burn to back & legs
Due to: Dress caught on fire in front of open fire place
at home
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: 25 April 1943
Transcribed by Debbie Tamborski, 06 February 2010 |
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