|
DEATH
CERTIFICATE
PAULINE STACEY
Date: 12 January 1951
Cert: 02107
Place of Death: County: Fayette City or Town:
Lexington
Length of stay (in this place):
Name of Hospital or Institution: St. Joseph
Usual Residence of Deceased: State: Ky. County:
Letcher
City or Town: Carbon Glow Street Address: (blank)
Full Name: Pauline STACEY
Date of Death: 12 January 1951
Sex, Color or Race, Marital Status: Female, White,
Married
Date of Birth: 17 September 1895
Age: 55 years, 02 months, 25 days
Usual Occupation: Housewife
Kind of Industry or business: (blank)
Birthplace: Knot Co., Ky.
Father's Name: James M. COMBS
Mother's Maiden Name: Mary Ann SMITH
Was deceased ever in armed forces: no
Social Security No.: none
Informant: Wm. STACEY, husband
Disease or condition directly leading to death: Olfactory
groove meningioma
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (illegible) with patient in
extremis
Date of Operation: 12 January 1951
Major findings of operation: Olfactory groove meningioma,
massive in size
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 11 January 1951 to
12 January 1951, that I last saw the deceased alive on (blank), and
that death occurred at (blank), from the causes and on the
date stated above.
Date signed: 03 February 1951
Address: 200 West Second St.
Signature: (illegible) Chenault
Burial, Cremation or Removal: Burial
Date: 15 January 1951
Name of Cemetery or Crematory: Smithboro
Location: Cody, Ky.
Date received by local registrar: 08 February 1951
Registrar's Signature: D. A. Furlong
Funeral director & address: W. R. Milward,
Lexington, Ky.
Transcribed by Debbie Tamborski, 31 July 2010 |
|