Date:  23 February 1953
Cert:  06056 
Place of Death: County: Knott      City or Town: Anco
Length of stay (in this place): (blank)
Street address or location:  Home at Anco, Ky.
Usual Residence of Deceased: State: Kentucky   County: Knott
City or Town:  Anco    Street Address: (blank)
Full Name:  Sam J. BACK
Date of Death:  23 February 1953
Sex, Color or Race, Marital Status:  Male, White, Widowed
Date of Birth:  10 July 1869
Age:  83 years
Usual Occupation:  Farmer
Kind of Industry or business: Farm
Birthplace:  Breathitt Co., Kentucky
Father's Name:  Joseph BACK
Mother's Maiden Name:  Paulina CONARD
Was deceased ever in armed forces: no
Social Security No.:  none
Informant:  Scott BACK
Disease or condition directly leading to death: Congestive Heart Disease
Interval between onset and death:  06 months
Due to (b):  Senility
Due to (c):  Natural causes
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy:  No
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 February 1953 to 23 February 1953, that I last saw the deceased alive on 22 February 1953, and that death occurred at 9 a.m., from the causes and on the date stated above.
Date signed:  02 March 1953
Address:  Allock
Signature:  A. B. Pigman, M.D.
Burial, Cremation or Removal:  Burial
Date:  26 February 1953 1 p.m.
Name of Cemetery or Crematory:  Family Cemetery
Location:  Stevenson, Kentucky
Date received by local registrar: 05 March 1953
Registrar's Signature:  Rose B. Craft
Funeral director & address:  Maggard & Garrett Funeral Home, Hazard, Ky.
Transcribed by Debbie Tamborski, 05 February 2011