Date: 15 July 1943
Cert: 20678
Place of Death: County: Knott City or
Town: Hindman, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Hindman - Rural
Full Name: Mary STAMPER
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 25 May 1943
Age: 01 months, 21 days
Birthplace: Knot County
Occupation: Infant
Industry or business: (blank)
Father Name: Hiram STAMPER
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Martha KELLEY
Mother Birthplace: Knott Co., Ky.
Informant: (blank)
Burial Place: Stewart Cemetery
Date: 16 July 1943
Signature of funeral director: (blank)
Date received by local registrar: 03 September 1943
Registrar's Signature: Ida Livingston
Date of Death: 15 July 1943
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Pneumonia
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. W. Duke, M.D., Hindman, Ky.
Date signed: 04 October 1943
Transcribed by Debbie Tamborski, 27 October 2010 |