Montgomery County, Kentucky death certificate of Peachie Mae 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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MONTGOMERY COUNTY, KENTUCKY DEATH CERTIFICATE
1. Place of death
  a. County: Montgomery
  b. Voter precinct: Grassy Lick
  c. Inc. town: nothing listed
  d. City: Mt. Sterling
  e. Registration district number: 6756
  f. Primary registration district number: 3
  g. File number: 4781
  h. Registered number: nothing listed
2. Full name: Peachie Mae Henderson
3. Sex: female
4. Color or race: white
5. Single, married, widowed or divorced: single
5a. Infant of Roy Henderson
6. Date of birth: nothing listed
7. Age: 11 hours
8. Occupation: infant
9. Birthplace: Montgomery County, Kentucky
10. Name of father: Roy Henderson
11. Birthplace of father: Bath County, Kentucky
12. Maiden name of mother: Margaret Holland (should be Gertie Perkins...Margaret was Roy's mother)
13. Birthplace of mother: Lewis County, Kentucky (should be Bath County, Kentucky)
14. Informant: Roy Henderson of Mt. Sterling
15. Filed: February 1928   Registrar: Mrs. J. S. Mason
16. Date of death: February 6, 1928
17. I hereby certify, That I attended deceased from (nothing listed) to (nothing listed), that I last saw him alive on (nothing listed), and that death occurred on the date stated above at 1:00 PM.  The cause of death was as follows: premature birth.
18a. Where was disease contracted: nothing listed
18b. Signed: Morton Faulkner MD of Mt. Sterling, Kentucky date: February 6, 1928
19a. Place of burial: Crown Hill Cemetery
19b. Date of burial: February 7, 1928
20. Undertaker: A. L. Mitchell of Mt. Sterling, Kentucky