Date:   04 May 1956
Cert: #56-12607
Place of Death: County: Knott      City or Town:  Vest - Rural
Length of stay (in this place): (blank)
Full Name of Hospital or Institution:  (blank)
Usual Residence of Deceased: State: Ky.     County:  Knott
City or Town:  Vest            Residence on a Farm?: Yes
Street Address: (blank)     Residence inside City Limits?:  No
Full Name:  Jasper PATRICK 
Date of Death:  04 May 1956 
Sex, Color or Race, Marital Status:  Male, White, Married
Date of Birth:   07 November 1884
Age:  72 years
Usual Occupation:  Farmer
Kind of Industry or business: (blank)
Birthplace:  Knott Co., Ky. 
Father's Name:  Wm. PATRICK  
Mother's Maiden Name:  Vina GAYHEART 
Was deceased ever in armed forces:  No
Social Security No.: (blank)
Informant:  (blank) 
Disease or condition directly leading to death:  Hemorrhage
Interval between onset and death: 02 days
Due to (b): Pulmonary Tuberculosis
Interval between onset and death: 08 months
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy:  (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 03 May 1956 to 03 May 1956, that I last saw the deceased alive on 03 May 1956, and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  10 May 1956
Address:  Ary, Ky.
Signature: D. L. Martin, M.D.
Burial, Cremation or Removal: Burial
Date:  06 May 1956
Name of Cemetery or Crematory:  Patrick Cem.
Location:   Vest, Ky.
Date received by local registrar:  04 June 1956
Registrar's Signature: Myrtle Slone
Funeral director & address:  John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 26 March 2012