Date:  22 January 1956
Cert:  #56-1254
Place of Death: County: Knott    City or Town: Lackey - Rural
Length of stay (in this place): (blank)
Name of Hospital or Institution: Stumbo Mem. Hosp.
Usual Residence of Deceased: State: Ky.      County:  Knott
City or Town:  Mallie   Street Address: (blank)
Full Name:  Kenneth Ray SHORT
Date of Death:  22 January 1956
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth:  21 January 1956
Age: 01 days
Usual Occupation:  (blank)
Kind of Industry or business: (blank)
Birthplace:  Knott Co., Ky.
Father's Name:  Berlin SHORT
Mother's Maiden Name:  Velma SLONE
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  Berlin SHORT
Disease or condition directly leading to death: Atelactasis
Interval between onset and death:  36 hours
Due to:  (blank)
Other significant conditions: (blank)
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 21 January 1956 to 22 January 1956, that I last saw the deceased alive on 22 January 1956, and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  (blank)
Address:  Lackey, Ky.
Signature:  Charles L. Roach, M.D.
Burial, Cremation or Removal: Burial
Date:  23 January 1956
Name of Cemetery or Crematory:  Watts
Location:  Garner, Ky.
Date received by local registrar:  03 February 1956
Registrar's Signature: Myrtle Slone
Funeral director & address:  John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 25 March 2012