Date:   08 November 1942
Cert:   09347
Place of Death: County: Knott Co.  City or Town: Pippapass Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky     County: Knott
City or Town:  Pippapass  Rural
Full Name:  Dollie SHORT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White
Husband or Wife of:  (blank)
Age of husband or wife if alive:  (blank)
Birth date of deceased:  06 December 1941
Age: 11 months, 02 days
Birthplace:  Pippapass, Ky. Rural
Occupation:  None
Industry or business: (blank)
Father Name:  Hays SHORT
Father Birthplace:  Knott Co., Ky.
Mother Maiden Name:  Elsie SLONE
Mother Birthplace:  Knott Co., Ky.
Informant:  Mandy (her x mark) SHORT
Burial Place:  (blank)
Date:  (blank)
Signature of funeral director:  (blank)
Date received by local registrar:  11 March 1943
Registrar's Signature: Ida Livingston
Date of Death:  08 November 1942
I hereby certify that I attended deceased from (blank) to (blank), that I last saw him alive on 01 November, and that death occurred on the date stated above at 10 a.m.
Immediate cause of death:  Pneumonia
Duration: (blank)
Due to: (blank)
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 & Address: J. W. Duke, M.D., Hindman, Ky.
Date signed:  11 March 1943
Transcribed by Debbie Tamborski, 16 October 2010