Franklin County, Kentucky death certificate of Ewell Andrew Cline

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Date: Sun, 26 Jan 2003
Darrell Warner
From: http://www.genrecords.net/emailregistry/vols/00001.html#0000008
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KENTUCKY DEATH CERTIFICATE
File No. 91 28308
Registrar's no. 028583
1. Decedent's name
  a. First: Ewell
  b. Middle: Andrew
  c. Last: Warner
2. Sex: male
3. Date of death: November 8, 1991
4. Social security number: 401-50-9357
5. Age last birthday
  a. Years: 73
  b. Months & days: not listed
  c. Hours & minutes: not listed
6. Date of birth: September 30, 1918
7. Birthplace (city, state or foreign country): Bath County, Kentucky
8. Was decedent ever in Armed Forces: no
9. Place of death
  a. Hospital inpatient, er/outpatient or doa: hospital
  b. Facility name: Kings Daughter Memorial Hospital
  c. City, town or location of death: Frankfort
  d. County of death: Franklin County
10. Marital status: widowed
11. Surviving spouse (if wife give maiden name): nothing listed
12a. Decedent's usual occupation (give kind of work done during most of 
working life. Do not use retired): mechanic
12b. Kind of business/industry: Johnson Wheel
13. Residence
  a. State: Kentucky
  b. County: Franklin
  c. City, town or location: Frankfort
  d. Street and number: 1335 Louisville Road
  e. Inside city limits: yes
  f. Zip code: 40601
15. Race: white
16. Father's name (first, middle and last): W. H. Cline
17. Mother's name (first, middle and last): Edna Warner
19. Informant
  a. Name: Pattie Smith Glover
  b. Address: 109 Crystal Drive, Frankfort, Kentucky
20. Method of disposition
  a. Burial, cremation, donation, removal from state, other (specify): 
burial
  b. Place of disposition (name of cemetery, crematory or other place): 
Sunset Memorial Gardens
  c. Location (city, town or state): Woodford County
21. Signature of funeral services licence: Michael L. Harrod
22. Name and address of facility:  Harrod Brothers, 312 Washington Street, 
Frankfort, Kentucky 40601
23. To the best of my knowledge death occurred at the time, date and place 
and due to the causes stated
  a. Signature: Jerald S. Deedwy (best guess)
  b. Date signed: 11-8-1991
24. Name and address of person who completed cause of death (item 28): none 
listed
25. Time of death: none listed
26: Date pronounced dead: none listed
27. Was the case referred to medical examiner/coroner: nothing listed
28. Enter the disease, injuries, or complications that caused the death. 
Do not enter the mode of dying, such as cardiac or respiratory arrest, 
shock or heart failure.  List one cause on each line.
  a. Respiratory arrest
  b. pneumonia streptococci  2 weeks
  c. copd  20 years
  d. other significant conditions contributed to death but not resulting 
in the underlying: dementis-mo hi- infarct(best guess)
29. Manner of death (natural, accident, suicide, homicide, pending 
investigation, or could not be determined: nothing listed
30a. Date of injury: nothing listed
30b. Time of injury: nothing listed
30c. Injury at work: nothing listed
30d. Describe how injury occurred: nothing listed
30e. Place of injury: nothing listed
30f. Location: nothing listed
31. Registrar's signature: Robert N. Hurst III
32. Date filed: November 19, 1991