Date:   25 February 1941
Cert:   05247 
Place of Death: County: Knott Co.    City or Town: Mousie
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Mousie
Full Name:  Robert AMBURGY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of:  Nancy AMBURGY
Age of husband or wife if alive:  Deceased
Birth date of deceased:  11 October 1848
Age: 93 years, 04 months, 15 days
Birthplace:  Pinetop, Ky.
Occupation:  Farmer
Industry or business: (blank)
Father Name:  Unknown
Father Birthplace:  Unknown
Mother Maiden Name:  Unknown
Mother Birthplace:  Unknown
Informant:  Sherill COBURN, Mousie, Ky.
Burial Place:  Mousie
Date:  26 February 1941
Signature of funeral director: Ed Howard, Garrett, Ky.
Date received by local registrar:  28 February 1941
Registrar's Signature:  Macie Miller
Date of Death:  25 February 1941
I hereby certify that I attended deceased from (blank) to (blank), that I last saw him alive on (blank), and that death occurred on the date stated above at (blank)
Immediate cause of death:  Hart [sic] failure
Duration: (blank) 
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: Hart [sic] failure
Date of occurrence: (blank)
Where did injury occur: Home
While at work: (blank)
Means of injury: (blank)
Signature & Address:  J. W. Duke, M.D., Hindman
Date signed:  (blank)
Transcribed by Debbie Tamborski, 08 October 2010