Date 22 October 1940
Cert: 24242
Place of Death: County: Knott City or Town: Lackey
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Ivan
Full Name: Fred B. AMBURGEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Lillie AMBURGEY
Age of husband or wife if alive: 35 years
Birth date of deceased: 22 May 1902
Age: 38 years, 06 months
Birthplace: Knott County, Kentucky
Occupation: Farming
Industry or business: (blank)
Father Name: Ben AMBURGEY
Father Birthplace: (blank)
Mother Maiden Name: Mollie COLLINS
Mother Birthplace: (blank)
Informant: Lillie AMBURGEY, Ivan, Ky.
Burial Place: (blank)
Date: (blank)
Signature of funeral director: (blank)
Date received by local registrar: 23 October 1940
Registrar's Signature: Macie Miller
Date of Death: 22 October 1940
I hereby certify that I attended deceased from 07 October 1940 to 22 October 1940, that I last saw h-- alive on 22 October 1940, and that death occurred on the date stated above at 3:25 p.m.
Immediate cause of death: Enlarged heart
Duration: (blank)
Due to: (blank)
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 & Address: W. L. Stumbo, M.D., Lackey, Ky.
Date signed: 22 October 1940
Transcribed by Debbie Tamborski, 16 August 2010