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DEATH
CERTIFICATE
NANCY AMBURGEY
Date 13 April 1942
Cert: 08676
Place of Death: County: Floyd City or Town: Langley
Maytown
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Langley Rural Precinct: Maytown 32
Full Name: Nancy AMBURGEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: John AMBURGEY
Age of husband or wife if alive: 85 years
Birth date of deceased: 28 May 1857
Age: 84 years, 10 months, 16 days
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Jess BURGEY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Rachel CORNETTE
Mother Birthplace: Knott Co., Ky.
Informant: Mrs. Dean AMBURGEY, Langley, Ky.
Burial Place: Langley, Ky.
Date: 14 April 1942
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 01 May 1942
Registrar's Signature: Mrs. Ben Norris
Date of Death: 13 April 1942
I hereby certify that I attended deceased from 1942 to
(blank), that I last saw her alive on 1942, and that death
occurred on the date stated above at 10:20 a.m.
Immediate cause of death: Uremia
Duration: (blank)
Due to: Chr. nephritis
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: C. L. Allen, M.D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 21 May 2010 |
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