|
DEATH
CERTIFICATE
JOHN S. AMBURGEY
Date: 27 January 1953
Cert: 03617
Place of Death: County: Letcher City or Town:
Polly, Ky.
Length of stay (in this place): (blank)
Street address or location: Home
Usual Residence of Deceased: State: Ky. County:
Letcher
City or Town: Polly, Ky. Street
Address: Camp Branch Ck.
Full Name: John S. AMBURGEY
Date of Death: 27 January 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 31 March 1881
Age: 71 years, 09 months, 27 days
Usual Occupation: Miner
Kind of Industry or business: Howard Polly Coal Co.
Birthplace: Knott Co., Ky.
Father's Name: John AMBURGEY
Mother's Maiden Name: Virginia AMBURGEY
Was deceased ever in armed forces: (blank)
Social Security No.: 404-28-5672
Informant: Pearl AMBURGEY (Son)
Disease or condition directly leading to death: Valvular
heart Disease
Interval between onset and death: 02 years
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: no
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 26 January 1953 to
26 January 1953, that I last saw the deceased alive on 26
January 1953, and
that death occurred at 5 p.m., from the causes and on the
date stated above.
Date signed: 07 February 1953
Address: Whitesburg, Ky.
Signature: Carl Pigman, M.D.
Burial, Cremation or Removal: Burial
Date: 29 January 1953
Name of Cemetery or Crematory: Family Cemetery
Location: Polly, Ky.
Date received by local registrar: 02 February 1953
Registrar's Signature: G. W. Collins
Funeral director & address: Archie Craft,
Whitesburg, Ky.
Transcribed by Debbie Tamborski, 12 August 2010 |
|