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DEATH
CERTIFICATE
BERNICE MARTIN
Date: 12 July 1947
Cert: 16508
Place of Death: County: Perry City or Town:
Bulan
Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Bulan
Full Name: Bernice MARTIN
If Veteran Name War: #2
Social Security No.: 403-22-5859
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 27 November 1911
Age: 35 years, 07 months, 15 days
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: Mechanic
Father Name: Ben MARTIN
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Delilah SMITH
Mother Birthplace: Knott Co., Ky.
Informant: Ben MARTIN, Bulan, Ky.
Burial Place: Engle Cem.
Date: 14 July 1947
Signature of funeral director: Maggard & Blair, Hazard, Ky.,
by R. E. Cox
Date received by local registrar: 07 August 1947
Registrar's Signature: Pearl G. Combs by (illegible)
Date of Death: 12 July 1947
I hereby certify that I attended deceased from 02 July 1947 to
12 July 1947, that I last saw him alive on 12 July 1947, and
that death occurred on the date stated above at 11:30 p.m.
Immediate cause of death: Far advance (illegible)
Pulmonary tuberculosis & cavity formation
Duration: 02 years
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Paul W. Gutscter, M.D., Hazard,
Ky.
Date signed: 14 July 1947
Transcribed by Debbie Tamborski, 24 June 2010 |
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