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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

Vot. Pct:  MOOK

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5317

Primary Registration District No:  

File No.  24266

Registered No:  15

2.       FULL NAME:   ALEXANDER, MARGERETE LEE

PERSONAL AND STATISTICAL PARTICULARS

3.       SEX:     FEMALE

4.       COLOR OR RACE:  WHITE

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

6.       DATE OF BIRTH: SEP 5, 1912

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):   0 / 1 / 1 

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:  MACK ALEXANDER

11.   BIRTHPLACE OF FATHER:  KY

12.   MAIDEN NAME OF MOTHER:  LETA DAVIS

13.   BIRTHPLACE OF MOTHER:  KY

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

(Informant)  ROSCO CARMAN

(Address)  LOCUST HILL, KY

15.   Filed  

REGISTAR:  

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  OCT 6, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  OCT 3, 1912 to OCT 6, 1912

That I last saw him/her alive on (date):  OCT 5, 1912

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

THE CAUSE OF DEATH was as follows:  BRONCHO PNEUMONIA

 

(Duration)   Years:            Months:            Days:  5

Contributory:  

 

(Duration)   Years:            Months:            Days:  

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

Date:  OCT 6, 1912

Address:  CUSTER

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:  ALEXANDER

DATE OF BURIAL:  OCT 7, 1912

20.   UNDERTAKER:  LOCUST HILL

ADDRESS:  

 

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Copyright.  All rights reserved.
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