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DEATH
CERTIFICATE
NANCY STACY
Date: 21 June 1950
Cert: 13561
Place of Death: County: Breathitt City or Town:
Jackson
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Breathitt
City or Town: Jackson Street Address: (blank)
Full Name: Nancy STACY
Date of Death: 21 June 1950
Sex, Color or Race, Marital Status: Female, White, Widow
Date of Birth: 05 May 1865
Age: 85 years
Usual Occupation: At Home
Kind of Industry or business: (blank)
Birthplace: Knott County, Ky.
Father's Name: Wayne COMBS
Mother's Maiden Name: Juda DOBSON
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: W. H. DEATON
Disease/condition directly leading to death: Gastro enteritis,
acute
Interval between onset and death: 24 hours
Due to: (blank)
Other significant conditions: Senile degenerative heart
disease
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: no
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: Jackson, Breathitt, Ky.
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 21 June 1950 to
21 June 1950, that I last saw the deceased alive on 21 June
1950, and
that death occurred at 11:00 a.m., from the causes and on the
date stated above.
Date signed: (blank)
Address: Jackson, Ky.
Signature: F. C. Lewis, M.D.
Burial, Cremation or Removal: Removal
Date: (blank)
Name of Cemetery or Crematory: Woodside
Location: Middletown, Ohio
Date received by local registrar: 26 June 1950
Registrar's Signature: Gladys H. Deaton
Funeral director & address: Ray & Blake, Jackson,
Ky.
Transcribed by Debbie Tamborski, 21 July 2010 |
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