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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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PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pct:  WEBSTER

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  24218

Registered No: 

1.       FULL NAME:  ALDRIGE, EMELLY JANE

PERSONAL AND STATISTICAL PARTICULARS

2.       SEX:     FEMALE

3.       COLOR OR RACE:  WHITE

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

5.       DATE OF BIRTH: 3/24/1911

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

7.       OCCUPATION (a.) Trade, profession or particular kind of work:  

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

8.       BIRTHPLACE:  BRECKINRIDGE

9.       NAME OF FATHER:  WILLIAM ALDRIGE

10.   BIRTHPLACE OF FATHER:  BRECKINRIDGE

11.   MAIDEN NAME OF MOTHER:  TENIA HULTZ

12.   BIRTHPLACE OF MOTHER:  BRECKINRIDGE

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

(Informant)  WM ALDRIGE

(Address)  WEBSTER, KY

14.   Filed  10/10/1912

REGISTAR:  H. DUNN

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  10/26/1912

16.   I HEREBY CERTIFY, That I attended deceased from (date):  SEP 10, 1912 to OCT 24, 1912

That I last saw him/her alive on (date):  OCT 25, 1912

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

THE CAUSE OF DEATH was as follows:  ANEMIA

 

(Duration)   Years:            Months:             Days:    

Contributory:  

 

(Duration)   Years:            Months:     1       Days:    15

Signed (M.D.):  T.J. HENDRICK

Date:  OCT 27, 1912

Address:  WEBSTER

17.   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:  

18.   PLACE OF BURIAL OR REMOVAL:  NO DATA LISTED

DATE OF BURIAL:  

19.   UNDERTAKER:  

ADDRESS:  

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