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DEATH
CERTIFICATE
POWELL W. COBURN
Date: 05 April 1945
Cert: 07163
Place of Death: County: Boyd City or Town:
Ashland
Street No. or Location: Residence - 2431 Roosevelt Ave.
Length of stay in hospital or community: 18 years
Usual Residence of Deceased: State: Kentucky County:
Boyd
City or Town: Ashland Street
No.: 2431 Roosevelt Ave.
Full Name: Powell W. COBURN
If Veteran Name War: (blank)
Social Security No.: 402-05-0561
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Mrs. Amy COBURN
Age of husband or wife if alive: (blank)
Birth date of deceased: 11 April 1893
Age: 51 years, 11 months, 23 days
Birthplace: Knott Co., Ky.
Occupation: Carpenter, American
Industry or business: Rolling Mill, Ashland, Ky.
Father Name: J. C. COBURN
Father Birthplace: Floyd Co., Ky.
Mother Maiden Name: Jo Ann CALHOUN
Mother Birthplace: Knott Co., Ky.
Informant: (wife) Mrs. Amy COBURN, 2431 Roosevelt Ave.
Burial Place: Rosehill
Date: 08 April 1945
Signature of funeral director: John Stein, Ashland, Ky.
Date received by local registrar: 08 April 1945
Registrar's Signature: Mrs. C. P. Garten
Date of Death: 05 April 1945
I hereby certify that I attended deceased from 05 December
1943 to
04 April 1945, that I last saw him alive on 04 April 1945, and that death
occurred on the date stated above at 3:10 a.m.
Immediate cause of death: Myelogenous Leukemia
Duration: 02 1/2 years
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: (illegible) M.D., Ashland, Ky.
Date signed: 06 April 1945
Transcribed by Debbie Tamborski, 05 June 2010 |
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