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DEATH
CERTIFICATE
MART COMBS
Date 29 October 1940
Cert: 29769
Place of Death: County: Perry City or Town:
Rural
Name of Hospital or Institution: (Grigsby, Ky.)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural Street No.:
18
Full Name: Mart COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Froney COMBS
Age of husband or wife if alive: 57 years
Birth date of deceased: 1870
Age: 70 years
Birthplace: Knott Co., Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Sim COMBS
Father Birthplace: Perry Co., Ky.
Mother Maiden Name: Polly GAYHEART
Mother Birthplace: Knott Co., Ky.
Informant: Robert COMBS, Carrie, Ky.
Burial Place: Burial - Grigsby, Ky.
Date: 30 October 1940
Signature of funeral director: Engle Und. &
Hdwe. Co., Hazard, Ky.
Date received by local registrar: 12 December 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 29 October 1940
I hereby certify that I attended deceased from 04 June 1940 to
(blank), that I last saw him alive on 04 June 1940, and that death
occurred on the date stated above at (blank)
Immediate cause of death: Carcinoma of stomach
Duration: (blank)
Due to: (blank)
Major findings of operations/autopsy: None
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. N. Gross, M.D., Hazard, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 08 May 2010 |
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