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

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1. PLACE OF DEATH
County:  Breckinridge Co.
Vot. Pol.:  Big Spring
Inc Town:  Near Big Spring, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  5314
Primary Registration District No:  14
File No.  6240
Registered No:  18
2. FULL NAME:  Mary Adkisson
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  not known
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  about 81
8. OCCUPATION (a.) Trade, profession or particular kind of work:  none
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Ky
10. NAME OF FATHER:  William Adkisson
11. BIRTHPLACE OF FATHER:  nothing known
12. MAIDEN NAME OF MOTHER:  Pollie Guthrie
13. BIRTHPLACE OF MOTHER:  nothing known
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R. A. Kusey
(Address)  Custer, Ky
15. Filed  Mar 14, 1914
REGISTAR:  J. L. Morris
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Mar 11, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  Mar 1, to Mar 11, 1914
That I last saw him/her alive on (date):  Mar 11, 1914
And that death occurred on the date stated above at (time AM/PM):  11 AM
THE CAUSE OF DEATH was as follows:  Senility
 
(Duration)   Years:     2       Months:            Days:  
Contributory:  La Gripp
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R. W. Meador
Date:  March 11, 1914
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:  Adkisson Burying Ground
DATE OF BURIAL:  March 12, 1914
20. UNDERTAKER:  Alf Taylor
ADDRESS:  Custer, Ky
 

ADDITIONAL COMMENTS/NOTES:
 
 


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