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DEATH
CERTIFICATE
SAM CALHOUN
Date: 26 May 1946
Cert: 12924
Place of Death: County: Floyd City or Town:
Dwale, Ky.
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Dwale
Full Name: Sam CALHOUN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 17 February 1861
Age: 85 years
Birthplace: Knott
Occupation: (blank)
Industry or business: (blank)
Father Name: Tom CALHOUN
Father Birthplace: Knott
Mother Maiden Name: Mary HIGNITE
Mother Birthplace: Floyd
Informant: John CALHOUN, Dwale
Burial Place: Dwale
Date: 29 May 1946
Signature of funeral director: E. P. Arnold, Prestonsburg, Ky.
Date received by local registrar: 03 July 1946
Registrar's Signature: Lucy Ramsdell
Date of Death: 26 May 1946
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Infirmities of old age
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Marvin Ramsdell, MD,
Prestonsburg, Ky.
Date signed: 02 July 1946
Transcribed by Debbie Tamborski, 07 June 2010 |
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