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DEATH
CERTIFICATE
JEROME R. YARBER
Date 14 September 1941
Cert: 23068
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural
Full Name: Jerome R. YARBER
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: (blank)
Age: 02 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Rube YARBER
Father Birthplace: Tenn.
Mother Maiden Name: Leo KELLEY
Mother Birthplace: Knott Co.
Informant: Jim MARTIN, Sassafras, Ky.
Burial Place: Sassafras
Date: 15 September 1941
Signature funeral director: Engle Und. & Hdw. Co., Hazard, Ky.
Date received by local registrar: 30 September 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 14 September 1941
I hereby certify that I attended deceased from 12 September
1941 to 14 September 1941, that I
last saw him alive on 14 September 1941 and that death occurred on the date
stated above at 5 p.m.
Immediate cause of death: diffuse peritonitis
Due to: Ruptured appendix
Major findings of operations: Ruptured appendix and
peritonitis
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 23 September 1941
Transcribed by Debbie Tamborski, 02 February 2010 |
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