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DEATH
CERTIFICATE
THOMAS SMITH
Date: 03 September 1951
Cert: 18888
Place of Death: County: Madison City or Town:
Berea
Length of stay (in this place): 01
Name of Hospital or Institution: Berea College Hospital
Usual Residence of Deceased: State: Ky. County:
Clay
City or Town: Garrard Street Address: (blank)
Full Name: Thomas SMITH
Date of Death: 03 September 1951
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 16 November 1884
Age: 66 years
Usual Occupation: R. R. Agent
Kind of Industry or business: R. R.
Birthplace: Knot County, Ky.
Father's Name: William SMITH
Mother's Maiden Name: Metilda AMBURGERY
Was deceased ever in armed forces: No
Social Security No.: 704-07-6306
Informant: Thomas SMITH, Jr.
Disease/condition directly leading to death: Internal
hemorrhage
Interval between onset and death: 48 hours
Due to: Aneurysm of aorta - dissecting
Other significant conditions: (blank)
Date of Operation: 02 September 1951
Major findings of operation: hemorrhage from (illegible) aorta
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 01 September
1951 to
03 September 1951, that I last saw the deceased alive on (blank), and
that death occurred at 6:30 p.m., from the causes and on the
date stated above.
Date signed: 07 September 1951
Address: Berea, Ky.
Signature: J. C. Baker, M.D.
Burial, Cremation or Removal: Burial
Date: 06 September 1951
Name of Cemetery or Crematory: Engine
Location: Blue Hole, Clay Co., Ky.
Date received by local registrar: 12 September 1951
Registrar's Signature: Lillian Warren
Funeral director & address: C. Fred Rominger,
Rominger Funeral Home, Manchester, Kentucky
Transcribed by Debbie Tamborski, 31 July 2010 |
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