|
DEATH
CERTIFICATE
Mr. JAMES COMBS
Date 24 December 1939
Cert: Original #29625
Place of Death: County: Floyd City or
Town: Wayland
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Floyd
City or Town: Wayland
Full Name: Mr. James COMBS
If Veteran Name War: (blank)
Social Security No.: 403-07-7639
Sex, Color or Race, Marital Status: Male, White, Widower
Husband or Wife of: deseased [sic]
Age of husband or wife if alive: (blank)
Birth date of deceased: 17 July 1890
Age: 49 years, 05 months, 07 days
Birthplace: Knott Co.
Occupation: Miner
Industry or business: (blank)
Father Name: Frank COMBS
Father Birthplace: Knott Co.
Mother Maiden Name: Sarah ALLEN
Mother Birthplace: Knott Co.
Informant: Kendall COMBS, Wayland, Ky.
Burial Place: Estill, Ky.
Date: 26 December 1939
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 28 December 1939
Registrar's Signature: Mrs. Ben Norris
Date of Death: 24 December 1939
I hereby certify that I attended deceased from 15 December
1939 to 24 December 1939, that I last saw him alive on 23
December 1939, and that death occurred on the date stated
above at (blank)
Immediate cause of death: Progressive Muscular Atrophy
Hypertensive Heart Disease
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: A. B. Pigman, Wayland, Ky.
Date signed: 28 December 1939
Transcribed by Debbie Tamborski, 03 May 2010 |
|