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DEATH
CERTIFICATE
PHILIP TOLLIVER
Date 28 September 1944
Cert: 13456
Place of Death: County: Perry Co. City or
Town: Allock
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Spider, Ky.
Full Name: Philip TOLLIVER
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 25 August 1944
Age: 01 months, 03 days
Birthplace: Kentucky
Occupation: (blank)
Industry or business: (blank)
Father Name: Denver TOLLIVER
Father Birthplace: Kentucky
Mother Maiden Name: Ettie ADAMS
Mother Birthplace: Kentucky
Informant: Denver TOLLIVER, Spider, Ky.
Burial Place: Amburgey
Date: 29 September 1944
Signature of funeral director: W. S. Tolliver, Neon, Ky.
Date received by local registrar: 11 June 1945
Registrar's Signature: Opsie J. Deaton
Date of Death: 28 September 1944
I hereby certify that I attended deceased from 10 August 194? to
16 September 1945, that I
last saw him alive on 16 September 1945, and that death occurred on the date
stated above at (blank)
Immediate cause of death: Pneumonia
Due to: Malnutrition
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: T. J. Chandler, M.D., Allock, Ky.
Date signed: 06 June 1945
Transcribed by Debbie Tamborski, 08 February 2010 |
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