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DEATH
CERTIFICATE
HENRY STACY
Date 27 March 1912
Cert: 06162
Place of Death: Voting Precinct: Spring Fork, Breathitt Co.,
Ky.
Full Name: Henry STACY
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: (blank)
Age: 30 years
Occupation: Farmer
Birthplace: Knott Co.
Name of Father: M. D. STACY
Birthplace Father: Knott Co.
Maiden name of Mother: Lunah ENGLE
Birthplace Mother: Knott Co.
Informant/Address: Shelton RUSSELL, Lunah, Ky.
Filed: 29 March 1912
Registrar: A. D. (illegible)
Death Date: 27 March 1912
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: (blank)
Signed/Address: (blank)
Where was disease contracted: At place of death
Former or Usual Residence: Lunah, Ky.
Place of Burial or Removal: Stacy Graveyard
Date of Burial: 29 March 1912
Undertaker/Address: Alice Stacy, Lunah
Transcribed by Debbie Tamborski, 24 February 2010 |
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