Date: 02 October 1947
Cert: 28501
Place of Death: County: Knott City or
Town: Lackey, Ky. Rural
Name of Hospital or Institution: Stumbo Mem.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Lackey, Rural
Full Name: Stephen Edmond SCOTT
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: 01 October 1947
Age: 17 hours
Birthplace: Lackey, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Herman SCOTT
Father Birthplace: Floyd Co., Ky.
Mother Maiden Name: Christine DUFF
Mother Birthplace: (illegible)
Informant: Herman SCOTT, Garrett, Ky.
Burial Place: Garrett, Ky.
Date: 03 October 1947
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 14 January 1948
Registrar's Signature: Rose B. Craft
Date of Death: 02 October 1947
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 12:00 noon.
Immediate cause of death: Respiratory failure
Duration: (blank)
Due to: atelectasis, left lung
Other conditions: none
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: C. M. Aker, M.D., Lackey, Ky.
Date signed: 12 January 1948
Transcribed by Debbie Tamborski, 20 December 2010 |