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DEATH
CERTIFICATE
ESTILL WALTERS
Date 26 February 1941
Cert: 05778
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Perry
City or Town: Bulan Street No.:
Rural
Full Name: Estill WALTERS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 27 years
Birthplace: Knott Co., Ky.
Occupation: Truck Driver
Industry or business: (blank)
Father Name: Jim WALTERS
Father Birthplace: Breathitt Co., Ky.
Mother Maiden Name: Margaret SMITH
Mother Birthplace: Knott Co., Ky.
Informant: Jim WALTERS, Bulan, Ky.
Burial Place: Bulan, Ky.
Date: 27 February 1941
Signature of funeral director: Engle Und. & Hdwe., Hazard, Ky.
Date received by local registrar: 03 March 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 26 February 1941
I hereby certify that I attended deceased from 25 February
1941 to 26 February 1941, that I last saw him alive on 26
February 1941, and that death
occurred on the date stated above at 2:45 a.m.
Immediate cause of death: Diffuse peritonitis
Duration: 04 days
Due to: Ruptured appendix Duration:
04 days
Major findings of operations: diffuse peritonitis, ruptured
appendix
Accident, suicide, or homicide: no
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 01 March 1941
Transcribed by Debbie Tamborski, 21 May 2010 |
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