|
DEATH
CERTIFICATE
JASPER BYRD
STAMPER
Date: 19 December 1949
Cert: 27680
Place of Death: County: Perry City or Town:
Dwarf
Length of stay (in this place): (blank)
Name of Hospital or Institution: Home
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Dwarf Street Address: (blank)
Full Name: Jasper Byrd STAMPER
Date of Death: 19 December 1949
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 02 September 1885
Age: 64 years, 03 months, 07 days
Usual Occupation: Farmer
Kind of Industry or business: (blank)
Birthplace: Knott Co., Ky.
Father's Name: Marion STAMPER
Mother's Maiden Name: Martha Ann STEWARD
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Mrs. Jasper STAMPER
Disease/condition directly leading to death: Myocarditis,
Chronic
Interval between onset and death: 04 years
Due to: Bronchial Asthma
Interval between onset and death: 15 years
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: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased on 19 December 1949
only, that I last saw the deceased alive on 19 December 1949, and
that death occurred at 10 p.m., from the causes and on the
date stated above.
Date signed: 31 December 1949
Address: Homeplace Clinic & Hospital
Signature: Paul E. Adolph, M.D., F.A.C.S.
Burial, Cremation or Removal: Burial
Date: 21 December 1949
Name of Cemetery or Crematory: Stamper
Location: Perry Co., Ky.
Date received by local registrar: 21 March 1950
Registrar's Signature: Georgia Pendleton
Funeral director & address: Engle's, Hazard, Ky.
Transcribed by Debbie Tamborski, 13 July 2010 |
|