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DEATH
CERTIFICATE
MARY COBURN
Date: 21 March 1949
Cert: 09221
Place of Death: County: Floyd City or Town:
Lackey, Ky.
Length of stay (in this place): 50 years
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Lackey, Ky. Street Address: (blank)
Full Name: Mary COBURN
Date of Death: 21 March 1949
Sex, Color or Race, Marital Status: Female, White,
Married
Date of Birth: 18 July
Age: 70 years
Usual Occupation: (blank)
Kind of Industry or business: Domestic
Birthplace: Carr Creek, Knott
Father's Name: R. H. AMBURGY
Mother's Maiden Name: Nancie MARTIN
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: (blank)
Disease or condition directly leading to death: Cardio
Vascular
Interval between onset and death: 05 years
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
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 1948 to
02 March 1949, that I last saw the deceased alive on 02 March
1949, and
that death occurred at 6 a.m., from the causes and on the
date stated above.
Date signed: (blank)
Address: Wayland, Ky.
Signature: M. V. Wicker, M.D.
Burial, Cremation or Removal: (blank)
Date: 21 March 1949
Name of Cemetery or Crematory: Campbell Cem.
Location: Mousie, Knott, Ky.
Date received by local registrar: 12 May 1949
Registrar's Signature: Lucy Ransdell
Funeral director & address: G. D. Ryan, Martin, Ky.
Transcribed by Debbie Tamborski, 12 July 2010 |
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