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DEATH
CERTIFICATE
MATTIE AMBURGY
Date 15 July 1949
Cert: 13709
Place of Death: County: Floyd City or
Town: (illegible)tin
Length of stay (in this place): (blank)
Name of Hospital or Institution: Beaver Valley Hospital
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: Melvin Street Address:
Rural
Full Name: Mattie AMBURGY
Date of Death: 15 July 1949
Sex, Color or Race, Marital Status: Female, White, Widowed
Date of Birth: March 1902
Age: 47 years, 04 months
Usual Occupation: Housewife
Kind of Industry or business: (blank)
Birthplace: Knott County, Ky.
Father's Name: Unknown
Mother's Maiden Name: Unknown
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Cecil ROSE
Disease or condition directly leading to death: Gun shot
wounds
Interval between onset and death: 01 day
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
Accident, suicide, or homicide: Homicide
Place of injury: Home
City or Town, County, State: Melvin, Floyd Co., Ky.
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 13 July 1949 to
15 July 1949, that I last saw the deceased alive on 15 July
1949, and that death occurred at 1:20 a.m., from the causes
and on the date stated above.
Date signed: 16 July 1949
Address: Martin, Ky.
Signature: C. L. Allen, M.D.
Burial, Cremation or Removal: Burial
Date: 16 July 1949
Name of Cemetery or Crematory: Family
Location: Hindman, Knott County, Kentucky
Date received by local registrar: 27 July 1949
Registrar's Signature: Lucy Ransdell
Funeral director & address: J. W. Call & Son, Pikeville,
Ky.
Transcribed by Debbie Tamborski, 02 July 2010 |
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