Date: 23 April 1944
Cert: 13002
Place of Death: County: Knott City or
Town: Amburgey (rural)
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Amburgey (rural)
Full Name: Robert CHANEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Eartha CHANEY
Age of husband or wife if alive: 44 years
Birth date of deceased: 03 June 1880
Age: 63 years, 10 months, 20 days
Birthplace: Breathitt Co., Ky.
Occupation: Miner
Industry or business: (blank)
Father Name: Robert CHANEY
Father Birthplace: Breathitt Co., Ky.
Mother Maiden Name: Eartha COMBS
Mother Birthplace: Vicco, Kentucky
Informant: Eartha CHANEY, Amburgey, Ky.
Burial Place: Vicco, Ky.
Date: 25 April 1944
Signature of funeral director: None - Friends, Amburgey,
Ky.
Date received by local registrar: 24 March 1945
Registrar's Signature: Rose B. Craft
Acting Registrar Per B. Carns
Date of Death: 23 April 1944
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: Ruptured Peptic ulcer
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: J. R. Aker, M.D., Anco, Ky.
Date signed: 23 March 1945
Transcribed by Debbie Tamborski, 08 November 2010 |