Date: 02 March 1941
Cert: 10596
Place of Death: County: Knott City or
Town: Rural
Street No. or Location: own home
Length of stay in hospital or community: all life
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural If rural,
give precinct: Garner
Full Name: Delmas B. SLONE
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: 11 November 1940
Age: 03 months, 19 days
Birthplace: Garner, Ky., Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Charlie SLONE
Father Birthplace: Garner, Ky., Knott Co.
Mother Maiden Name: Annie THACKER
Mother Birthplace: Knott Co., Ky.
Informant: Charlie SLONE, Garner
Burial Place: Garner, Ky.
Date: 03 March 1941
Signature of funeral director: (blank)
Date received by local registrar: 28 April 1941
Registrar's Signature: Macie Miller
Date of Death: 02 March 1941
I hereby certify that I attended deceased from 02 March 1941 to
02 March 1941, that I last saw him alive on 02 March 1941, and
that death occurred on the date stated above at 12:30 p.m.
Immediate cause of death: Broncho Pneumonia
Duration: 04 days
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: Mark Dempsey, M.D., Hindman, Ky.
Date signed: 22 April 1941
Transcribed by Debbie Tamborski, 15 October 2010 |