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DEATH
CERTIFICATE
SAM YOUNG
Date: 20 October 1953
Cert: 26216
Place of Death: County: Perry City or Town:
Darbfork
Length of stay (in this place): (blank)
Street address or location: Residence
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Darbfork Street Address: (blank)
Full Name: Sam YOUNG
Date of Death: 20 October 1953
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 10 June 1898
Age: 55 years, 04 months, 10 days
Usual Occupation: Janitor
Kind of Industry or business: Ky. & W. Va. Power Company
Birthplace: Knott County, Ky.
Father's Name: Manford YOUNG
Mother's Maiden Name: Martha RITCHIE
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: Betty YOUNG
Disease or condition directly leading to death: Myocarditis
Interval between onset and death: (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (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 (blank) to
(blank), that I last saw the deceased alive on 20 October 1953, and
that death occurred at 6 p.m., from the causes and on the
date stated above.
Date signed: 02 November 1953
Address: Hazard, Ky.
Signature: S. M. Richie, M.D.
Burial, Cremation or Removal: Burial
Date: 22 October 1953
Name of Cemetery or Crematory: Reese Young Cemetery
Location: Lotts Creek, Perry, Ky.
Date received by local registrar: 02 November 1953
Registrar's Signature: Georgia P. Surer
Funeral director & address: Wm. Engle, Jr., Hazard,
Ky.
Transcribed by Debbie Tamborski, 13 August 2010 |
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