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DEATH
CERTIFICATE
VELMA A. BOLEYN
Date 09 March 1940
Cert: 08329
Place of Death: Vot. Pct. (illegible) #22, Dwarf, Perry Co.,
Ky.
Full Name: Velma A. BOLEYN
Residence: Dwarf, Ky.
Length of Residence: 04 years, 08 months
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Everett BOLEYN
Date of Birth: 17 April 1910
Age: 29 years, 10 months, 08 days
Occupation: Housewife
Birthplace: Ky. (Knott Co.)
Father Name: Chester AMBURGEY
Birthplace Father: Ky.
Mother Maiden Name: -- PIGMAN
Birthplace Mother: Ky.
Informant/Address: Everett BOLEYN, Dwarf, Ky.
Burial Cremation Removal Place: Dwarf, Ky.
Date: 10 March 1940
Undertaker/Address: (illegible), Hazard, Ky.
Filed: 20 March 1940
Registrar: Eunice H. Ribble
Death of Date: 09 March 1940
I hereby certify, That I attended deceased from 01 March 1940
to 09 March 1940, that I last saw her alive on 09 March 1940,
death is said to have occurred on the date stated above, at
4:30 a.m.
Cause of Death: Arthritis acute
Date of onset: (illegible)
Contributory causes: Influenza and pregnancy
Date of onset: 07 weeks
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: Sue Richie, M.D., Hazard, Ky.
Transcribed by Debbie Tamborski, 08 May 2010 |
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