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DEATH
CERTIFICATE
BENJAMIN STACEY
Date: 20 September 1946
Cert: 21122
Place of Death: County: Clay City or Town:
Garrard
Street No. or Location: (blank)
Length of stay in hospital or community: 29 years
Usual Residence of Deceased: State: Kentucky County:
Clay
City or Town: Garrard
Full Name: Benjamin STACEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Margret STACEY
Age of husband or wife if alive: 70 years
Birth date of deceased: 10 December 1855
Age: 90 years, 09 months, 10 days
Birthplace: Knott Co., Ky.
Occupation: Farmer
Industry or business: Farm
Father Name: Shade STACEY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Sallie COMBS
Mother Birthplace: Knott Co., Ky.
Informant: Basil STACY, Garrard, Ky.
Burial Place: Cordia, Ky.
Date: 22 September 1946
Signature funeral director: C. Fred Rominger, Manchester, Ky.
Date received by local registrar: 26 September 1946
Registrar's Signature: Ann H. Lucas
Date of Death: 20 September 1946
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 5:35 p.m.
Immediate cause of death: Cerebral hemorrhage
Duration: 10 days
Due to: Hypertensive Heart Disease
Duration: unknown
Other conditions: Pellegra
Duration: unknown
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: W. E. Nichols, Manchester, Ky.
Date signed: 21 September 1946
Transcribed by Debbie Tamborski, 11 June 2010 |
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