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DEATH
CERTIFICATE
JURDON T. ASHLEY
Date 28 July 1941
Cert: 20837
Place of Death: County: Perry City or Town:
Rural
Name of Hospital or Institution: none
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural
Full Name: Jurdon T. ASHLEY
If Veteran Name War: Worlds War
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Virgie ASHLEY
Age of husband or wife if alive: 34 years
Birth date of deceased: 29 April 1893
Age: 48 years, 02 months, 29 days
Birthplace: Knott Co., Kentucky
Occupation: Miner
Industry or business: Mine
Father Name: Jack ASHLEY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Polly PRIDEMORE
Mother Birthplace: Knott Co., Ky.
Informant: James ASHLEY, Amburgy, Ky.
Burial Place: Amburgy, Ky.
Date: (blank)
Signature of funeral director: D. F. Burke, Hazard, Ky.
Date received by local registrar: 10 August 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 28 July 1941
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), and that death
occurred on the date stated above at 9 a.m.
Immediate cause of death: Intra cranial hemorrhage
Duration: (blank)
Due to: (Basal illegible) of skull
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 28 July 1941
Transcribed by Debbie Tamborski, 12 May 2010 |
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