|
DEATH
CERTIFICATE
SIMEON FUGATE
Date 03 February 1928
Cert: 03005
Place of Death: Voting Pct. No. 23, Breathitt Co., Ky.
Full Name: Simeon FUGATE
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 27 April 1894
Age: 33 years, 02 months, 24 days
Occupation: Farmer
Birthplace: Knott Co.
Name of Father: Hiram FUGATE
Birthplace Father: Breathitt
Maiden name of Mother: Betsyan STACY
Birthplace Mother: Breathitt
Informant/Address: Hiram FUGATE, (illegible)
Filed: 04 February 1928
Registrar: A. D. Russell
Death Date: 03 February 1928
I hereby certify that I attended deceased from 15 January
1927, to 03 February 1928, that I last saw h-- alive on
(blank), and that death occurred, on the date stated above at
1 a.m.
Cause of Death: cancer of bowels
Duration: (blank)
Contributory: (blank)
Signed/Address: Dr. Swango, M.D., Jackson
Place of Burial or Removal: Russell Cemetery
Date of Burial: 04 February 1928
Undertaker/Address: none
Transcribed by Debbie Tamborski, 26 March 2010 |
|