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DEATH
CERTIFICATE
HIRAM BEVERLEY
Date 06 July 1940
Cert: 26281
Place of Death: County: Floyd City or Town:
Allen rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Allen rural
Full Name: Hiram BEVERLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: 87 years
Birth date of deceased: (blank)
Age: about 77 years
Birthplace: Knott Co., Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Hiram BEVERLEY
Father Birthplace: Virginia
Mother Maiden Name: SLONE
Mother Birthplace: Knott Co., Ky.
Informant: Ken. BEVERLEY, Allen, Ky.
Burial Place: Knott Co., Ky.
Date: 08 July 1940
Signature of funeral director: none
Date received by local registrar: 06 November 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 06 July 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Cancer of face
Duration: 02 years
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: Marvin Ramsdall, MD,
Prestonsburg, Ky.
Date signed: 06 November 1941
Transcribed by Debbie Tamborski, 08 May 2010 |
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