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1.	PLACE OF DEATH
County:  BRECKINRIDTGE
Vot. Pol.:  WEBSTER
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5311
File No.  3591
Registered No:  
2.	FULL NAME:  ALDRICH, CHARLES
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE 
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6.	DATE OF BIRTH:  DEC 14, 1912
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 / 2/ / 0
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  WEBSTER
10.	NAME OF FATHER:  WILLIAM ALDRICH
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE
12.	MAIDEN NAME OF MOTHER:  TINIE HULTZ
13.	BIRTHPLACE OF MOTHER:  ALLEN COUNTY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  T.J. HENDRICK
(Address)  WEBSTER
15.	Filed  FEB 11, 1913
REGISTAR:  T. DRANE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  FEB 11, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  FEB 10, 1913 to FEB 11, 1913
That I last saw him/her alive on (date):  FEB 11, 1913
And that death occurred on the date stated above at (time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  PNEUMONIA

(Duration)   Years:            Months:            Days:     2
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  T.J. HENDRICK
Date:  
Address:  WEBSTER
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:  WEBSTER
DATE OF BURIAL:  FEB 10, 1913   [DATE AS RECORDED]
20.	UNDERTAKER:  H.C. - - - - -
ADDRESS:  WEBSTER


ADDITIONAL COMMENTS/NOTES:




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

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