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DEATH
CERTIFICATE
POLLY STACY
Date: 03 July 1946
Cert: 16320
Place of Death: County: Perry City or Town:
(blank)
Street No. or Location: Hazard Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Dwarf
Full Name: Polly STACY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Brack STACY
Age of husband or wife if alive: (blank)
Birth date of deceased: 02 February
Age: 34 years
Birthplace: Knott
Occupation: House wife
Industry or business: (blank)
Father Name: Dave NOBLE
Father Birthplace: Breathitt
Mother Maiden Name: Sarah STACY
Mother Birthplace: Perry
Informant: Brack STACY, Dwarf, Ky.
Burial Place: Dwarf, Ky.
Date: 03 July 1946
Signature of funeral director: Jimmie Blair, Hazard, Ky.
Date received by local registrar: 03 July 1946
Registrar's Signature: Opsie J. Deaton
Date of Death: 03 July 1946
I hereby certify that I attended deceased from 02 June 1946 to
03 July 1946, that I last saw him alive on 03 July 1946, and
that death occurred on the date stated above at 12:05 a.m.
Immediate cause of death: Gun shot wound (410) of
abdomen. hemorrhage & shock
Duration: 05 hours
Due to: (blank)
Major findings of operations: 2 large holes in stomach -
Transversal colon cut into - kidney & spleen both were removed
because they were shot to pieces
Accident, suicide, or homicide: suicide
Date of occurrence: 02 June 1946 [sic]
Where did injury occur: home
While at work: (blank)
Means of injury: (blank)
Signature & Address: W. F. O'Donnell, Jr., M.D.,
Hazard, Ky.
Date signed: 03 July 1946
Transcribed by Debbie Tamborski, 11 June 2010 |
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