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DEATH
CERTIFICATE
JOHN B. BOLEN
Date: 04 November 1951
Cert: 23319
Place of Death: County: Montgomery City or Town:
Rural
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Kentucky County:
Floyd
City or Town: Garrett Street Address: (blank)
Full Name: John B. BOLEN
Date of Death: 04 November 1951
Sex, Color or Race, Marital Status: Male, White, Widowed
Date of Birth: 25 October 1875
Age: 76 years, 00 months, 09 days
Usual Occupation: Farmer
Kind of Industry or business: Own Farm
Birthplace: Knott County, Ky.
Father's Name: J. R. BOLEN
Mother's Maiden Name: Christine GAYHEART
Was deceased ever in armed forces: no
Social Security No.: (blank)
Informant: Tandy BOLEN
Disease/condition directly leading to death: Coronary
Occlusion
Interval between onset and death: 06 hours
Due to: (blank)
Other significant conditions: Berger's Disease
Interval between onset and death: 06 years
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 04 November
1951 to
04 November 1951, that I last saw the deceased alive on 04
November 1951, and
that death occurred at 1:30 p.m., from the causes and on the
date stated above.
Date signed: 05 November 1951
Address: Mt. Sterling, Kentucky
Signature: Frank Sewell, M.D.
Burial, Cremation or Removal: Burial
Date: 06 November 1951
Name of Cemetery or Crematory: Bolen
Location: Knott County, Kentucky
Date received by local registrar: 05 November 1951
Registrar's Signature: Elizabeth Wyatt
Funeral director & address: Eastin-Richey, Mt.
Sterling, Ky.
Transcribed by Debbie Tamborski, 22 July 2010 |
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