Date: 04 November 1953
Cert: 23321
Place of Death: County: Knott
City or Town: Rural
Length of stay (in this place): All of life
Street address or location: Bolyn, Ky.
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural If
rural give location: Bolyn, Ky.
Full Name: William Rice BOLEN
Date of Death: 04 November 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 30 May 1883
Age: 70 years
Usual Occupation: Farmer
Kind of Industry or business: Farming
Birthplace: Knott Co., Ky.
Father's Name: W. W. BOLEN
Mother's Maiden Name: Nancy HOLLIDAY
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Oscar BOLEN
Disease or condition directly leading to death: Pulmonary
Tuberculosis
Interval between onset and death: years
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
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 (blank) to
(blank), that I last saw the deceased alive on (blank), and
that death occurred at (blank), from the causes and on the
date stated above.
Date signed: 05 November 1953
Address: Hindman, Ky.
Signature: Jno. N. Taul (Coroner)
Burial, Cremation or Removal: Burial
Date: 07 November 1953
Name of Cemetery or Crematory: Bolen Cemetery
Location: Bolyn, Ky., Knott Co.
Date received by local registrar: 28 November 1953
Registrar's Signature: Rose B. Craft
Funeral director & address: John N. Taul, Hindman,
Ky.
Transcribed by Debbie Tamborski, 07 February 2011 |