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DEATH
CERTIFICATE
DORCEY (DORSEY)
PERKINS
Date 22 May 1940
Cert: 11880
Place of Death: County: Fayette City or Town: Lexington,
Ky.
Name of Hospital or Institution: Eastern State Hospital
Length of stay in hospital or community: 03 years
Usual Residence of Deceased: State: Kentucky County: Perry
City or Town: (blank)
Full Name: Dorcey (Dorsey) PERKINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 34 years
Birthplace: Knott County, Kentucky
Occupation: None
Industry or business: (blank)
Father Name: No Record
Father Birthplace: " "
Mother Maiden Name: " "
Mother Birthplace: "
"
Informant: Hospital Records, Eastern State Hospital,
Lexington, Kentucky
Burial Place: Avamwam
Date: 24 May 1940
Signature of funeral director: W. S. Norris, Hazard, Ky.
Date received by local registrar: 27 May 1940
Registrar's Signature: D. A. Furlong
Date of Death: 22 May 1940
I hereby certify that I attended deceased from 08 October 1940 to
22 May 1940, that I last saw him alive on 22 May 1940, and
that death occurred on the date stated above at 10:40 p.m.
Immediate cause of death: Fractured skull,
hemorrhage--struck with blunt instrument in hands of psychotic
pt.
Duration: (blank)
Due to: Post Encephalitic syndrome
Duration: 03 years
Accident, suicide, or homicide: Homicide
Date of occurrence: 20 May 1940
Where did injury occur: In hospital
While at work: (blank)
Means of injury: (blank)
Signature & Address: C. C. Counce, MD, Eastern State
Hosp.
Date signed: 22 May 1940
Transcribed by Debbie Tamborski, 10 May 2010 |
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