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DEATH
CERTIFICATE
JACK COMBS
Date: 12 March 1950
Cert: 06065
Place of Death: County: Perry City or Town:
Darfork
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Darfork Street Address: (blank)
Full Name: Jack COMBS
Date of Death: 12 March 1950
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: April 1870
Age: 79 years
Usual Occupation: (blank)
Kind of Industry or business: Farmer
Birthplace: Knott Co.
Father's Name: Fieldon COMBS
Mother's Maiden Name: Mint GODSEY
Was deceased ever in armed forces: no
Social Security No.: no
Informant: Douglas COMBS
Disease or condition directly leading to death:
Hypertensive Cardio-Vascular Disease
Interval between onset and death: 12 years
Due to: Myocardial failure
Interval between onset and death: 03 months
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: no
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 July 1949 to 12
March 1950, that I last saw the deceased alive on 11 March
1950, and
that death occurred at 5:10 p.m., from the causes and on the
date stated above.
Date signed: 17 March 1950
Address: Harveyton, Ky.
Signature: Russell C. McLucas, M.D.
Burial, Cremation or Removal: (blank)
Date: (blank)
Name of Cemetery or Crematory: (blank)
Location: (blank)
Date received by local registrar: 20 March 1950
Registrar's Signature: Georgia Pendleton
Funeral director & address: (blank)
Transcribed by Debbie Tamborski, 14 July 2010 |
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