Bath County, Kentucky death certificate of Robert William Henderson

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Date: Sun, 26 Jan 2003
Darrell Warner
From: http://www.genrecords.net/emailregistry/vols/00001.html#0000008
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BATH COUNTY DEATH CERTIFICATE
File number: 60 18716
Registrar's number: 57
Registration district: 50
Primary registration district number: 4081
1. Place of death
  a. County: Bath
  b. City or town; rural
  c. Length of stay: residence
  d. Street address: Sharpsburg, Kentucky RR #1
2. Usual residence
  a. State: Kentucky
  b. County: Bath
  c. City or town: rural
  d. Street address: Sharpsburg, Kentucky RR #1
3. Name of deceased: Robert William Henderson
4. date of death: September 17, 1960
5. Sex: male
6. Color or race: white
7. married, never married, widowed or divorced: married
8. Date of birth: June 22, 1899
9. Age: 61
10a. Usual occupation: farmer
10b. Kind of business or industry: farming
11. Birthplace: Bath County
12. Citizen of what country: U.S.A.
13. Father's name: Robert Henderson
14. Mother's maiden name: Margaret Holland
15. Was deceased ever in U.S. Armed Forces: no
16. Social security number: 400-52-2998
17. Informant: Mrs. Ella Stewart Henderson
18a. Immediate cause of death: pulmonary embolism
18b. Interval between onset and death: 10 weeks
18c. Vascular occlusion in left leg for 3 weeks
19. Was autopsy performed: no
20. Accident, suicide or homicide: nothing listed
21. Describe how injury occurred: nothing listed
22. I hereby certify, that I attended the deceased from September 1, 
1960 to September 17, 1960, that I last saw him alive on September 12, 
1960, and that death occurred at 6:45 PM, from the causes and on the 
date stated above.
23a. Date signed: September 27, 1960
23b. Address: Mt. Sterling, Kentucky
23c. Signature: M. Bush MD
24a. Burial, cremation or removal: burial
24b. Date of burial: September 19, 1960
24c. Name of Cemetery: Crown Hill
24d. Location of cemetery: Sharpsburg
25a. Date received by local Registrar: September 19, 1960
25b. Registrar's signature: Lena P. Brooks
26. Funeral director: Eastin & Richey of Mt. Sterling, Kentucky