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DEATH
CERTIFICATE
SUSANNA OWENS
Date 25 April 1950
Cert: 10833
Place of Death: County: Perry City or Town: (blank)
Length of stay in hospital or community: 02 days
Name of Hospital or Institution: Homeplace Clinic & Hosp.
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Rural - Ritchie, Ky.
Full Name: Susanna OWENS
Date of Death: 25 April 1950
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth: 1912
Age: 38 years
Usual Occupation: (blank)
Kind of Industry or business: Housewife
Birthplace: Breathitt Co., Ky.
Father's Name: (blank)
Mother's Maiden Name: (blank)
Was deceased in ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Husband - Jason OWENS
Disease or condition directly leading to death (a):
Obstructive jaundice
Interval between onset and death: 06 days
Due to (b): Carcinoma of Liver
Interval between onset and death: 01 year
Due to (c): Carcinoma of Uterus
Interval between onset and death: 06 years
Other significant conditions: Acute myocardial failure
Date of Operation: (blank)
Major findings for operation: (blank)
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 23 April 1950
to 25 April 1950, that I last saw the deceased alive on 24
April 1950, and that death occurred on the date stated above
at 4:25 a.m., from the causes and on the date stated above.
Date signed: 26 April 1950
Address: Homeplace, Ary, Ky.
Signature: Paul E. Adolph, M.D.
Burial, Cremation or Removal: (blank)
Date: (blank)
Name of Cemetery or Creamatory: (blank)
Location: (blank)
Date received by local registrar: 16 May 1950
Registrar's Signature: Georgia Pendleton
Funeral director and address: (blank)
Transcribed by Debbie Tamborski, 17 February 2010 |
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