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DEATH
CERTIFICATE
MAC BENTLEY
Date 22 February 1942
Cert: 04305
Place of Death: County: Leslie City or Town:
Rural
Street No. or Location: (blank)
Length of stay in hospital or community: 50
Usual Residence of Deceased: State: Ky. County:
Leslie
City or Town: Rural
Full Name: Mac BENTLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Nannie BENTLEY
Age of husband or wife if alive:
Birth date of deceased: 09 October 1872
Age: 69 years, 04 months, 13 days
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Ben BENTLEY
Father Birthplace: ? [sic]
Mother Maiden Name: Annie RAYMOND
Mother Birthplace: ? [sic]
Informant: Florence Samson, F.N.S., Hyden, Ky.
Burial Place: Hyden
Date: 24 Febraury 1942
Signature of funeral director: Rock House Family, Hyden, Ky.
Date received by local registrar: 28 February 1942
Registrar's Signature: Nettie H. Bowling
Date of Death: 22 February 1942
I hereby certify that I attended deceased from 18 February
1942 to 21 February 1942, that I last saw him alive on 21
February 1942, and that death
occurred on the date stated above at 9:30 p.m.
Immediate cause of death: Senility Chronic Myocarditis
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: L. H. Wagers, M.D., Hyden, Ky.
Date signed: 02 March 1942
Transcribed by Debbie Tamborski, 25 May 2010 |
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