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DEATH
CERTIFICATE
ADAM TERRY
Date 27 November 1952
Cert: 26810
Place of Death: County: Perry City or Town:
Hazard
Length of stay in hospital or community:
Name of Hospital or Institution: Mt. Mary Hosp.
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Talcum Street address:
Talcum
Full Name: Adam TERRY
Date of Death: 27 November 1952
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 03 March 1885
Age: 67 years, 08 months, 24 days
Usual Occupation: Miner
Kind of Industry or business: Coal Mines
Birthplace: Kentucky
Father's Name: Thomas TERRY
Mother's Maiden Name: Sylvinia PATRICK
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Mrs. Adam TERRY
Disease/condition directly leading to death: Cerebral
hemorrhage
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: Hodgkins Disease
Date of Operation: (blank)
Major findings of operation: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 23 November
1952 to
27 November 1952, that I
last saw the deceased alive on 27 November 1952, and that death occurred on
the date stated above at 5:52 a.m., from the causes and on the date
stated above.
Date signed: 29 November 1952
Address: Hazard, Ky.
Signature: Martin Palmer, M.D.
Burial, Cremation or Removal: Burial
Date: 29 November 1952
Name of Cemetery or Creamatory: Terry Cemetery
Location: Talcum, Knott, Kentucky
Date received by local registrar: 01 December 1952
Registrar's Signature: Georgia P. Surer
Funeral director and address: Engle Funeral Home,
Hazard, Ky., Wm. Engle, Jr.
Transcribed by Debbie Tamborski, 20 February 2010 |
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