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DEATH
CERTIFICATE
BURLEY MARTIN
Date 25 September 1924
Cert: 21298
Place of Death: Voting Precinct: Court House, Richmond,
Madison Co., Ky.
Full Name: Burley MARTIN
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 07 February 1888
Age: 36 years, 07 months, 18 days
Occupation: Miner
Birthplace: Hindman, Knot Co., Ky.
Name of Father: William MARTIN
Birthplace Father: Knot Co., Ky.
Maiden name of Mother: Rachel YOUNG
Birthplace Mother: Knot Co., Ky.
Informant/Address: R. B. MARTIN, Hazzard, Ky.
Filed: 25 September 1924
Registrar: J. T. Grigg
Death Date: 25 September 1924
I hereby certify that I attended deceased from 12 September
1924, to
25 September 1924, that I last saw him alive on 25 September
1924, and that death occurred, on the date stated above, at 12
?.m.
Cause of Death: Cardiac Asthma
Duration: 12 days
Contributory: (blank)
Signed/Address: B. H. Gibson, M.D., 25 September 1924,
Richmond, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Hazzard, Ky.
Date of Burial: 26 September 1924
Undertaker/Address: Blakeman, Roberts, & (illegible),
Richmond, Ky.
Transcribed by Debbie Tamborski, 20 March 2010 |
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