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DEATH
CERTIFICATE
MONROE BOLEN JR.
Date 30 June 1917
Cert: 19291
Place of Death: Vot. Precinct: Wayland, Martin, Floyd
Co., KY
Full Name: Monroe BOLEN Jr.
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 04 April 1894
Age: 23 years, 02 months, 20 days
Occupation: Farmer
Birthplace: Knott Co., Ky.
Name of Father: Monroe BOLEN Sr.
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Charlotte HICKS
Birthplace Mother: Knott Co., Ky.
Informant/Address: Monroe BOLEN Sr., Lackey, Ky.
Filed: (blank)
Registrar: G. S. Howard
Death Date: 30 June 1917
I hereby certify that I attended deceased from 24 June 1917, to
29 June 1917, that I last saw him alive on 29 June 1917, and
that death occurred, on the date stated above, at 3 a.m.
Cause of Death: Gun shot wound of liver
Duration: (blank)
Contributory: (blank)
Signed/Address: E. H. Maggard, M.D., 30
June 1917, Wayland, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 28 February 2010 |
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