Registration District No. 60           Primary Registration District No. 2031

Name of Deceased:   Harrison M. Surgner           Date of Death:  August 16, 1967

Sex:  Male         Color or Race:   White          Marital Status:  Married
Date of Birth:  January 3, 1888 Age:  79 yrs, 7 months, 13 days
Usual Occupation:  Miner                   Kind of Business or Industry:   Mining
Birthplace:  Bell County, KY          Citizen of what country:   USA

Fatherās Name:  Stevenson Surgner  Motherās Maiden Name:  Elsie White

Was deceased ever in the U.S. Armed Forces?  No  
Social Security No.:  Unknown

Informant:  Birdie Surgner   (Wife)

Medical Certification:
Cause of Death:  (a)  Cerebrovascular disease
Due to:  (b)  Generalized arteriosclerosis
Due to:  (c)  Senility

I hereby certify that I attended the deceased from Jan., 1950 to August 16, 1967, that I last saw the deceased alive on August 16, 1967, and that death occurred at 4:45 p.m. from the causes and on the date stated above.     Signed:  Charles B. Stacy,  M.D.
      August 17, 1967    Pineville, KY

Burial, 8-19-1967  Bradford Cemetery (Brafford),  Grays, KY
Funeral Director:  W.F. Durham    Pineville, KY
Date recād by local reg.  Aug. 21, 1967;  Registrarās Signature:  Edward Smith
 
 
 

*****NOTE:  Anything typed in parenthesis is added by the transcriber and is not on the death certificate. ****
 

transcribed by Kristi Cox