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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  STEPHENSPORT
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  9036
Registered No: 74 
2.	FULL NAME:  ADKINS, ALFRED A.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  APR 27, 1840
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  75 / 0 / 0
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMING
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER:  BARTON ADKINS
11.	BIRTHPLACE OF FATHER:  HARDIN CO, KY
12.	MAIDEN NAME OF MOTHER:  MARY WHEELER
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE 
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  EVERETT ADKINS [by phone]
(Address)  SAMPLE, KY
15.	Filed  APR 26, 1915
REGISTAR:  R.A. SHELLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APR 27, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  APR 13, 1915 to APR 15, 1915
That I last saw him/her alive on (date):  APR 15, 1915
And that death occurred on the date stated above at (time AM/PM):  12 NOON
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS OF THE LUNGS
(Duration)   Years:            Months:   ABT 5          Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): WILLIAM L. MILNER 
Date:  APR 27, 1915
Address:  UNION STAR
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19.	PLACE OF BURIAL OR REMOVAL:  SAMPLE, KY
DATE OF BURIAL:  APR 25, 1915
20.	UNDERTAKER:  C.A. TINIUS
ADDRESS:  STEPHENSPORT


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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