Date: 02 September 1950
Cert: 26635
Place of Death: County: Knott
City or Town: Lackey
Length of stay (in this place): (blank)
Full Name of Hospital or Institution: Stumbo Memorial
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: Garrett Street Address:
(blank)
Full Name: Buelah Ann SHEPHERD
Date of Death: 02 September 1950
Sex, Color or Race, Marital Status: Female, White,
Infant
Date of Birth: unknown
Age: 05 months
Usual Occupation:
Kind of Industry or business: (blank)
Birthplace: Garrett, Ky.
Father's Name: Ezra SHEPHERD
Mother's Maiden Name: Tavey VANDERPOOL
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Ezra SHEPHERD
Disease or condition directly leading to death:
Pseudomonas Enteritis
Interval between onset and death: 05 days
Due to (b): Dehydration
Due to (c): (illegible)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
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 (illegible)
1950 to
(illegible) 1950, that I last saw the deceased alive on (illegible), and
that death occurred at (blank), from the causes and on the
date stated above.
Date signed: 27 November 1950
Address: Lackey, Ky.
Signature: Martha A. Loving, M.D.
Burial, Cremation or Removal: Burial
Date: 03 September 1950
Name of Cemetery or Crematory: Bently
Location: Garrett, Floyd Co., Ky.
Date received by local registrar: 29 November 1950
Registrar's Signature: Rose B. Craft
Funeral director & address: John C. Hall, Martin,
Ky.
Transcribed by Debbie Tamborski, 16 January 2011 |