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DEATH
CERTIFICATE
SILAS DEAN
AMBURGY
Date 01 May 1940
Cert: 11981
Place of Death: County: Floyd City or
Town: Martin
Name of Hospital or Institution: Martin General Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: Langley Street
No.: Rural
Full Name: Silas Dean AMBURGY
If Veteran Name War: (blank)
Social Security No.: 403-10-1754
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Lucinda
Age of husband or wife if alive: 54 years
Birth date of deceased: 30 July 1881
Age: 58 years, 09 months, 01 days
Birthplace: Knott Co.
Occupation: Machinis [sic]
Industry or business: Warfield Natural Gas
Father Name: John AMBURGY
Father Birthplace: Knott Co.
Mother Maiden Name: Nancie AMBURGY
Mother Birthplace: Knott Co.
Informant: Mrs. Edd GAZAY, Jeff, Ky.
Burial Place: Langley
Date: 03 May 1940
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 03 May 1940
Registrar's Signature: Mrs. Ben Norris
Date of Death: 01 May 1940
I hereby certify that I attended deceased from 29 April 1940
to 01 May 1940, that I last saw him alive on 01 May 1940, and
that death occurred on the date stated above at 8:00 a.m.
Immediate cause of death: (blank)
Duration: (blank)
Due to: Carcinoma of stomach & metastasis to liver
Duration: 10 - 15 years
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: R. W. Allen, M.D., Martin, Ky.
Date signed: 01 May 1940
Transcribed by Debbie Tamborski, 08 May 2010 |
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