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DEATH
CERTIFICATE
BALIS COUCH
Date 17 January 1912
Cert: # 5783
Name: Balis COUCH
Male, White, Married
Age: 40 years, 05 months, 28 days
Place of Death: Voting Precinct #11 Hazard, Perry Co., KY
Birth Date: 20 May 1872
Occupation: Farmer
Place of Birth: Perry Co.
Name of Father: Eli COUCH
Birthplace Father: Perry Co.
Maiden Name of Mother: Polly COUCH
Birthplace Mother: Perry Co.
Informant: His Brother, Hazard, Ky.
Death Date: 17 January 1912
Cause of Death: Caused from a (?lick?) in the head which
caused concussion of brain
Signed: C. A. Eversole, M.D.
Burial Place: Hazard Cemetery
Date of Burial: 18 January 1912
Undertaker: (blank)
File Date: 15 March 1912
Transcribed by Debbie Tamborski, 02 December 2008 |
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