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DEATH
CERTIFICATE
DELTA AMBURGY
Date 10 October 1944
Cert: 28209
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Littcarr
Full Name: Delta AMBURGY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 40 years
Birthplace: Kentucky
Occupation: None
Industry or business: None
Father Name: W. J. AMBURGY
Father Birthplace: (blank)
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: (blank)
Burial Place: (blank)
Date: (blank)
Signature of funeral director: Maggards
Date received by local registrar: 01 December 1944
Registrar's Signature: (blank)
Date of Death: 10 October 1944
I hereby certify that I attended deceased from 06 October 1944 to
10 October 1944, that I
last saw him alive on 10 October 1944, and that death occurred on the date
stated above at 2:25 a.m.
Immediate cause of death: Empyema (rt)
Due to: lobar pneumonia
Major findings of operations: Rt. empyema
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 14 October 1945
Transcribed by Debbie Tamborski, 06 February 2010 |
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