|
DEATH
CERTIFICATE
HIRAM STACY
Date 21 July 1933
Cert: 18009
Place of Death: Voting Pct.: Jackson, Breathitt Co., Ky.
Full Name: Hiram STACY
Residence: (blank)
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Ellis STACY
Date of Birth: Don't know
Age: 42 years
Occupation: Farmer
Birthplace: Knott Co., Ky.
Father Name: M. D. STACY
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Luna ENGLE
Birthplace Mother: Perry Co., Ky.
Informant/Address: W. M. STACY, Hardburly, Ky.
Filed: 01 September 1933
Registrar: Mrs. A. W. Brown
Death of Date: 21 July 1933
I hereby certify that I attended deceased from 02 July 1933 to
21 July 1933, that I last saw him alive on 21 July 1933, and
that death occurred on the date stated above at 9:45 ?.m.
Cause of Death: Peritonitis following eruptive appendix
Duration: (blank)
Contributory: (blank)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: M. E. Hoge, MD, 21 July 1933, Jackson, Ky.
Place of Burial or Removal: Stacy Cemetery
Date of Burial: 22 July 1933
Undertaker/Address: L. (illegible) Ray, Jackson, Ky.
Transcribed by Debbie Tamborski, 02 April 2010 |
|