Date: 29 August 1948
Cert: 21284
Place of Death: County: Knott City or
Town: Dema, Ky.
Street Number or Location: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Dema Rural
Full Name: Juanita SLONE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 22 February 1948
Age: 06 months, 07 days
Birthplace: Dema, Ky. (Floyd Co.)
Occupation: (blank)
Industry or business: (blank)
Father Name: Clyde SLONE
Father Birthplace: Dema, Ky.
Mother Maiden Name: Wanda Lee LAFFERTY
Mother Birthplace: Garrett, Ky.
Informant: Clyde SLONE, Dema, Ky.
Burial Place: Dema, Ky.
Date: 30 August 1948
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 19 October 1948
Registrar's Signature: Rose B. Craft
Date of Death: 29 August 1948
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
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
Date signed: 18 October 1948
Transcribed by Debbie Tamborski, 29 December 2010 |