************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************
1.       PLACE OF DEATH

County:    BRECKINRIDGE

Vot. Pol.:  HUDSON

Inc Town:  

City:  

No.  

St.  

Ward  

Registration District No.:  

Primary Registration District No:  

File No.   11580  [BUT HANDWRITTEN 11680]

Registered No:  

2.       FULL NAME:  ADKINS, LYDIE A.

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  FEMALE

4.       COLOR OR RACE:  WHITE

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE

6.       DATE OF BIRTH:  MARCH 20, 1895

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  16 / 2 / 17

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  AT HOME

(b.)  General nature of industry business or establishment which employed:  

9.       BIRTHPLACE:   HARDIN CO, KY

10.   NAME OF FATHER:  ADKINS, TOM

11.   BIRTHPLACE OF FATHER:  BRECKINRIDGE CO, KY

12.   MAIDEN NAME OF MOTHER:  POWELL, MATTIE

13.   BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO, KY

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE  

(Informant)  GRAY, J.L

(Address)  CONSTANTINE, KY

15.   Filed  MAY 20, 1911

REGISTAR:  J.H. CORI- - - -  -

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  MAY 16, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date):  DEC 13, 1910 to MAR 24, 1911

That I last saw him/her alive on (date):  MAR 24, 1911

And that death occurred on the date stated above at (time AM/PM):  11 pm

THE CAUSE OF DEATH was as follows:  TUBERCULOSIS OF THE LUNGS

 

(Duration)  

Years:  

Months:  5

Days:  3

Signed (M.D.):  J.W. MEADOR

Date:  MAY 17, 1911

Address:  CUSTER, KY

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  GRAY GRAVEYARD

DATE OF BURIAL:  

20.   UNDERTAKER:  J.B. RICHARDSON

ADDRESS:  GARFIELD, KY

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************