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DEATH
CERTIFICATE
TILFORD BEVERLY
Date 29 July 1922
Cert: 16224
Place of Death: Voting Precinct: Fleming #17, Letcher
Co., Ky.
Full Name: Tilford BEVERLY
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: Don't know
Age: 34 years
Occupation: Miner Nature of Industry: Mining
Birthplace: Knott Co., Ky.
Name of Father: Robert BEVERLY
Birthplace Father: Ky.
Maiden name of Mother: Eliza Jane ARMSTRONG
Birthplace Mother: Ky.
Informant/Address: Jetharo BEVERLY, Storm King, Ky.
Filed: 17 August 1922
Registrar: W. B. Patterson
Death Date: 27 July 1922
I hereby certify that I attended deceased from 28 July 1922, to
29 July 1922, that I last saw him alive on 29 July 1922, and
that death occurred, on the date stated above, at 10 a.m.
Cause of Death: Injury of chest, leg, shoulder & head
Duration: (blank)
Contributory: Shock
Signed/Address: E. H. Maggard, M.D., 29
July 1922, Fleming, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Patton Fork
Date of Burial: 29 July 1922
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 19 March 2010 |
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