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DEATH
CERTIFICATE
DAN RILEY
Date 15 January 1952
Cert: 04747
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: 01 days
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Anco
Full Name: Dan RILEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Sarah RILEY
Age of husband or wife if alive: 25 years
Birth date of deceased: 05 November 1915
Age: 26 years
Birthplace: Owsley Co., Ky.
Occupation: Miner
Industry or business: (blank)
Father Name: George RILY
Father Birthplace: Ky.
Mother Maiden Name: Catherine FUGATE
Mother Birthplace: Ky.
Informant: (blank)
Burial Place: (ink smear) Cemetery (illegible)
Date: 17 (blank) 1942
Signature of funeral director: Wm. Engle, Hazard, Ky.
Date received by local registrar: 26 February 1942
Registrar's Signature: A. L. (illegible)
Date of Death: 15 January 1942
I hereby certify that I attended deceased from 15 January 1942 to
(blank), that I
last saw him alive on (blank), and that death occurred on the date
stated above at 7:30 p.m.
Immediate cause of death: Pulmonary hemorrhage
Due to: Pulmonary tuberculosis
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 January 1942
Transcribed by Debbie Tamborski, 05 February 2010 |
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