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DEATH
CERTIFICATE
T. A. AMBURGY, Sr.
Date 15 July 1936
Cert: 24201
Place of Death: Voting Pct.: Dwale, Floyd Co., Ky.
Full Name: T. A. AMBURGEY, Sr.
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: widowed
Date of Birth: 04 April 1865
Age: 72 years, 03 months, 11 days
Occupation: farmer
Birthplace: Knott Co., Ky.
Father Name: Wiley AMBURGY
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Lucy AMBURGY
Birthplace Mother: Knott Co., Ky.
Informant/Address: Ed AMBURGY, Dwale, Ky.
Burial Cremation Removal Place: Dwale, Ky.
Date: 17 July 1936
Undertaker/Address: E. P. Arnold, Prestonsburg, Ky.
Filed: 27 August 1936
Registrar: Theop. Salmons
Death of Date: 15 July 1936
I hereby certify, That I attended deceased from 1935 to
14 July 1936, that I last saw him alive on 15 July 1936, death is said
to have occurred on the date stated above, at (blank)
Cause of Death: Epelheleoma of left ear & side of face
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: none
What tests confirmed diagnosis: Previous tissue
(illegible)
Was there an autopsy: No
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: Ernest E. Martin, M.D., Allen, Ky.
Transcribed by Debbie Tamborski, 17 April 2010 |
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