Date: 13 October 1942
Cert: 01854
Place of Death: County: Knott City or
Town: Lackey
Name of Hospital or Institution: Stumbo Mem. Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Raven
Full Name: Marion 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: 14 February 1939
Age: 03 years, 07 months, 29 days
Birthplace: Raven, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Lema SLONE
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Melda MOSELY
Mother Birthplace: Knott Co., Ky.
Informant: Lema SLONE, Raven, Ky.
Burial Place: Raven, Ky.
Date: 15 October 1942
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 05 January 1943
Registrar's Signature: Ida Livingston
Date of Death: 13 October 1942
I hereby certify that I attended deceased from 12 October 1942 to
13 October 1942, that I last saw him alive on 13 October 1942, and that death
occurred on the date stated above at 3:00 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: C. J. Kelso, M.D.
Date signed: (blank)
Transcribed by Debbie Tamborski, 18 October 2010 |