|
DEATH
CERTIFICATE
DUTCHMAN COMBS
Date 11 August 1936
Cert: 20948
Place of Death: Voting Pct.: Jackson, Breathitt Co., Ky.
Full Name: Dutchman COMBS
Residence: Decoy, Ky., Knott Co.
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Rosette COMBS
Date of Birth: (blank)
Age: 72 years
Occupation: Farmer
Birthplace: Knott Co.
Father Name: Wayne COMBS
Birthplace Father: Kentucky
Mother Maiden Name: Juda DOBSON
Birthplace Mother: Kentucky
Informant/Address: Dan COMBS, Decoy, Ky.
Burial Cremation Removal Place: Decoy, Ky.
Date: 12 August 1936
Undertaker/Address: W. E. Blake, Jackson, Ky.
Filed: (blank)
Registrar: (blank)
Death of Date: 11 August 1936
I hereby certify, That I attended deceased from 11 August 1936 to
11 August 1936, that I last saw him alive on 11 August 1936, death is said
to have occurred on the date stated above, at 8:20 p.m.
Cause of Death: Arteriosclerosis, Mitral Heart
disease, Cerebral Embolus
Date of onset:
Contributory causes: (blank)
Name of operation: None Was there an
autopsy: No
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: Frank K. Sewell, M.D., Jackson, Ky.
Transcribed by Debbie Tamborski, 18 April 2010 |
|