|
DEATH
CERTIFICATE
DELLINOIS SLOAN
Date 04 June 1943
Cert: 13109
Place of Death: County: Floyd City or
Town: Martin
Name of Hospital or Institution: Martin General
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Raven
Full Name: Dellinois SLOAN
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: 28 February 1938
Age: 05 years, 03 months, 06 days
Birthplace: Raven, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: (blank)
Father Birthplace: (blank)
Mother Maiden Name: Polly SLOAN
Mother Birthplace: Wayland, Ky.
Informant: Lena SLOAN, Raven, Ky.
Burial Place: Raven, Ky.
Date: 05 June 1943
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 30 June 1943
Registrar's Signature: Winifred Norris
Date of Death: 04 June 1943
I hereby certify that I attended deceased from 03 June 1943 to
04 June 1943, that I
last saw him alive on 04 June 1943, and that death occurred on the date
stated above at 1:00 a.m.
Immediate cause of death: Toxemia
Due to: Ruptured appendix
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: C. L. Allen, M.D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 06 February 2010 |
|