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DEATH
CERTIFICATE
HENRY MELVIN BACK
Date 04 August 1951
Cert: 17030
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community: (illegible)
days
Name of Hospital or Institution: Mt. Mary Hospital
Usual Residence of Deceased: State: Ky. County: Knott
City or Town: Cody
Full Name: Henry Melvin BACK
Date of Death: 04 Augut 1951
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 04 December 1882
Age: 68 years
Usual Occupation: Stone Mason
Kind of Industry or business: Stone Mason
Birthplace: Kentucky
Father's Name: John S. BACK
Mother's Maiden Name: Elizabeth ROBERTS
Was deceased in ever in armed forces: no
Social Security No.: none
Informant: Vadis BACK, Cody, Ky.
Disease or condition directly leading to death:
Pulmonary Tuberculosis
Interval between onset and death: years
Due to: silicosis chronic nephritis
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings for operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 01 August 1951 to
04 August 1951, that I
last saw the deceased alive on 04 August 1951, and that death occurred on
the date stated above at 7:15 p.m., from the causes and on the date
stated above.
Date signed: 08 August 1951
Address: Hazard, Ky.
Signature: Martin Palmer, M.D.
Burial, Cremation or Removal: Burial
Date: 07 August 1951
Name of Cemetery or Creamatory: Cody Cemetery
Location: Cody, Ky.
Date received by local registrar: 18 August 1951
Registrar's Signature: Georgia P. (illegible)
Funeral director and address: Maggard & Garrett, Hazard,
Ky.
Transcribed by Debbie Tamborski, 17 February 2010 |
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