Date: 28 December 1951
Cert: 26633
Place of Death: County: Knott
City or Town: Emmalena
Length of stay (in this place): Life
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Emmalena Street Address:
(blank)
Full Name: Wiley A. COMBS
Date of Death: 28 December 1951
Sex, Color or Race, Marital Status: Male, White, (illegible)
Date of Birth: 06 January 1860
Age: 91 years
Usual Occupation: (illegible)
Kind of Industry or business: (blank)
Birthplace: (illegible)
Father's Name: (illegible)
Mother's Maiden Name: Polly PATTON
Was deceased ever in armed forces: (blank)
Social Security No.: None
Informant: (illegible)
Disease or condition directly leading to death: Disease of
heart
Interval between onset and death: (blank)
Due to: Senility
Other significant conditions: (blank)
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 01 December
1951 to
28 December 1951, that I last saw the deceased alive on 27
December 1951, and
that death occurred at 8 p.m., from the causes and on the
date stated above.
Date signed: 04 January 1952
Address: Hindman, Ky.
Signature: M. F. Kelley
Burial, Cremation or Removal: Burial
Date: (illegible) December 1951
Name of Cemetery or Crematory: Family Cemetery
Location: Emmalena, Ky.
Date received by local registrar: 04 January 1952
Registrar's Signature: Rose B. Craft
Funeral director & address: Charles F. Hornsby,
Hindman, Ky.
Transcribed by Debbie Tamborski, 18 January 2011 |