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DEATH
CERTIFICATE
ELLIS AMBURGY
Date 01 November 1933
Cert: 27301
Place of Death: Voting Pct. No. 25, Hazard
Hospital Co., Hazard, Ky.
Full Name: Ellis AMBURGEY
Residence: Ivan, Ky.
Length of Residence: Life
Sex, Color or Race, Marital Status: Male, White,
Divorced
Husband or Wife of: (blank)
Date of Birth: unknown
Age: 24 years
Occupation: Laborer
Birthplace: Knott Co., Ky.
Father Name: William AMBURGY
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Sallie AMBURGY
Birthplace Mother: Knott Co., Ky.
Informant/Address: Irvine AMBURGY, Ivan, Ky.
Burial Cremation Removal Place: Ivan, Ky.
Date: 01 November 1933
Undertaker/Address: Harve Engle, Hazard, Ky.
Filed: 25 November 1933
Registrar: J. P. Boggs
Death of Date: 01 November 1933
I hereby certify, That I attended deceased from 30 October
1933 to
01 November 1933, that I last saw him alive on 01 November
1933, death is said
to have occurred on the date stated above, at 5:20 a.m.
Cause of Death: Hemorrhage
Contributory causes: Gunshot wound of abdomen
Date of onset: 30 October 1933
Name of operation: apanotomy
Date of: 30 October 1933
Was there an autopsy: No
Accident, suicide, homicide: Homicide
Date of Injury: 30 October 1933
Where did injury occur: Ivan, Ky.
Specify whether injury occurred industry, home, public place:
Public Place
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: J. E. Hagan, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 01 April 2010 |
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