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DEATH
CERTIFICATE
MARTHA BURGEY
Date 02 September 1915
Cert: 25910
Place of Death: Voting Precinct: Lackey, Martin, Floyd
Co., Ky.
Full Name: Martha BURGEY
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: 17 July 1845
Age: 70 years, 09 months, 17 days
Occupation: Ordinary house duty
Birthplace: Knott Co., Ky.
Name of Father: Jessie BURGEY
Birthplace Father: Pinetop
Maiden name of Mother: Rachel CORNETT
Birthplace Mother: Knott Co., Ky.
Informant/Address: John AMBURGEY, Lackey, Ky.
Filed: (blank)
Registrar: G. S. Howard
Death Date: 02 September 1915
I hereby certify that I attended deceased from 20 August 1915, to
02 September 1915, that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: Flu?
Duration: (blank)
Contributory: (blank)
Signed/Address: Dr. M. M. Collins, M.D., 12 December
1915, Lackey, Ky.
Place of Burial or Removal: Dr. M. M. Collins Cemetery
Date of Burial: 03 September 1915
Undertaker/Address: John Amburgey, Lackey, Ky.
Transcribed by Debbie Tamborski, 25 February 2010 |
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