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DEATH
CERTIFICATE
FAIRLENA AMBURGY
Date 20 June 1922
Cert: 14268
Place of Death: Voting Precinct: Hazard, Perry Co., Ky.
Full Name: Fairlena AMBURGY
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth: unknown
Age: 32 years
Occupation: Wife
Birthplace: Knott Co., Ky.
Name of Father: Van Buren COMBS
Birthplace Father: Ky.
Maiden name of Mother: Ellen MOORE
Birthplace Mother: Ky.
Informant/Address: W. M. AMBURGEY, Bulan
Filed: 01 July 1922
Registrar: G. W. Nicholson
Death Date: 20 June 1922
I hereby certify that I attended deceased from 14 June 1922,
to 20 June 1922, that I last saw her alive on 20 June 1922,
and that death occurred, on the date stated above, at 4:15
p.m.
Cause of Death: Typhoid fever
Duration: 20 days
Contributory: (blank)
Signed/Address: J. D. Grant, M.D., 20 June 1922, Hazard, Ky.
Length of residence at place of death: 06 days
Where was disease contracted: at Bulan, Ky.
Former or usual residence: Bulan, Ky.
Place of Burial or Removal: W. D. Cordel
Date of Burial: Hazard, Ky.
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 07 March 2010 |
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