************************************************************************
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.:  Burleyville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5313
Primary Registration District No:  
File No.  13
Registered No:  
2. FULL NAME:  Mary Lee Adkisson
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  Dec 31, 1914
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  Stillborn
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Stillborn
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Garfield, Breckinridge Co.
10. NAME OF FATHER:  Ollie K. Adkisson
11. BIRTHPLACE OF FATHER:  Garfield, Breckinridge Co., Ky
12. MAIDEN NAME OF MOTHER:  Emma M. McCoy
13. BIRTHPLACE OF MOTHER:  Garfield, Breckinridge Co., Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Byron McCoy
(Address)  Garfield, Ky
15. Filed  [blank]
REGISTAR:  [blank]
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  December 31, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  Stillborn
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  stillborn due to convulsions
 
(Duration)   Years:            Months:            Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. Sandbach
Date:  Dec. 31, 1914
Address:  Garfield, 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:  [blank]
DATE OF BURIAL:  [blank]
20. UNDERTAKER:  [blank]
ADDRESS:  
 

ADDITIONAL COMMENTS/NOTES:
Breckinridge County Cemeteries Volume 1, page 3, shows Mary Lee Adkisson buried at Freedom Cumberland Presbyterian Church.
 



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