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DEATH
CERTIFICATE
OLVIN COMBS
Date 17 February 1932
Cert: 04834
Place of Death: Vot. Pct. #41. Bowling Green, Warren Co., Ky.
Full Name: Olvin COMBS
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 11 March 1915
Age: 17 years, 11 months, 06 days
Occupation: Student
Birthplace: Knott Co., Ky.
Father Name: Shade COMBS
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Sarah RICHEY
Birthplace Mother: Knott Co., Ky.
Informant/Address: Mrs. Karl COMBS, Bowling Green, Ky.
Burial Cremation Removal Place: Hazard, Ky.
Date: 19 February 1932
Undertaker/Address: (?Eb? illegible), Bowling Green, Ky.
Filed: 05 March 1932
Registrar: Geo. J. (illegible)
Death of Date: 19 February 1932
I hereby certify, That I attended deceased from 01 October
1932 [sic] to 19 February 1932, that I last saw him alive on
01 February 1932, death is said to have occurred on the date
stated above, at 8 p.m.
Cause of Death: Cardiac valvular lesion
Date of onset: (blank)
Contributory causes: Cardiac decompensation
Name of operation: (blank)
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: (blank)
Signed/Address: B. S. Rutherford, M.D.
Transcribed by Debbie Tamborski, 31 March 2010 |
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