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DEATH
CERTIFICATE
MOWRINE STAMPER
Date 17 September 1939
Cert: 26011
Place of Death: Vot. Pct.: Hazard Hosp., Hazard, Perry Co.,
Ky.
Full Name: Mowrine STAMPER
Residence: Anco
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, (blank)
Husband or Wife of: (blank)
Date of Birth: 26 October 1938
Age: 01 years
Occupation: Child
Birthplace: Knott Co., Ky.
Father Name: Randolph STAMPER
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Ruby DAVIDSON
Birthplace Mother: Knott Co., Ky.
Informant/Address: Randolph STAMPER, Anco, Ky.
Burial Cremation Removal Place: Burial - Littcar, Ky.
Date: 18 September 1939
Undertaker/Address: Engle Und. & Hdwe., Co., Hazard, Ky.
Filed: 07 November 1939
Registrar: Eunice H. Ribble
Death of Date: 17 September 1939
I hereby certify, That I attended deceased from 16 September
1939 to
17 September 1939, that I last saw her alive on 17 September
1939, death is said to have occurred on the date stated above,
at 8:30 a.m.
Cause of Death: Ileocolitis
Date of onset: (blank)
Contributory causes: Malnutrition
Name of operation: None Was there an autopsy:
No
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: J. E. Hagan, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 05 May 2010 |
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