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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  5307
Inc Town:  
City:   CLOVERPORT
No.  
St.  
Ward:  3rd
Registration District No.:  131
Primary Registration District No:  5307
File No.  11700
Registered No:  
2.	FULL NAME:  ALLEN, BARTLETT
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  COLORED
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JAN 8, 1841
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  74 / 3 / 28
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  GENERAL LABORER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  HANCOCK COUNTY
10.	NAME OF FATHER:  BARTLETT ALLEN
11.	BIRTHPLACE OF FATHER:  DON'T KNOW
12.	MAIDEN NAME OF MOTHER:  MARTHA PATE
13.	BIRTHPLACE OF MOTHER:  DON'T KNOW
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  WILLIAM ALLEN
(Address)  CLOVERPORT
15.	Filed  MAY 7, 1915
REGISTAR:  J.C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 6, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAR 15, 1915 to MAY 6, 1915
That I last saw him/her alive on (date):  MAY 2, 1915
And that death occurred on the date stated above at (time AM/PM):  10:30 AM
THE CAUSE OF DEATH was as follows:  ANGINA PECTORIS
(Duration)   Years:            Months:            Days:    4
Contributory:  LA GRIPPE
(Duration)   Years:            Months:     2       Days:  
Signed (M.D.):  C.R. LIGHTFOOT
Date:  MAY 6, 1915
Address:  CLOVERPORT
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:  CLOVERPORT
DATE OF BURIAL:  MAY 7, 1915
20.	UNDERTAKER:  M. HAMMAN & SONS
ADDRESS:  CLOVERPORT


ADDITIONAL COMMENTS/NOTES:




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