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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:  UNION STAR

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5309

Primary Registration District No:  

File No.  431

Registered No: 2

FULL NAME:  ALLEN, ELDEN HOLMES

PERSONAL AND STATISTICAL PARTICULARS

2.       SEX:     MALE

3.       COLOR OR RACE:  WHITE

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

5.       DATE OF BIRTH: JAN 26, 1912

6.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  3 DAYS

7.       OCCUPATION (a.) Trade, profession or particular kind of work:  NONE

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

8.       BIRTHPLACE:  BRECKINRIDGE CO

9.       NAME OF FATHER:  WILLIAM P. ALLEN

10.   BIRTHPLACE OF FATHER:  HANCOCK CO, KY

11.   MAIDEN NAME OF MOTHER:  HATTIE W. CASHMAN

12.   BIRTHPLACE OF MOTHER:  

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

(Informant)  C.W. CART

(Address)  MYSTIC, KY

14.   Filed  1/29/1912

REGISTAR:  LEE STEWART

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  JAN 29, 1912

16.   I HEREBY CERTIFY, That I attended deceased from (date):  JAN 26, 1912 to JAN 28, 19123

That I last saw him/her alive on (date):  JAN 28, 1912

And that death occurred on the date stated above at (time AM/PM):   8 AM

THE CAUSE OF DEATH was as follows:  SUPPRESSION OF URINE

 

(Duration)   Years:            Months:            Days:  

Contributory:  CONVULSIONS

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  WILLIAM L. MILNER

Date:  

Address:  UNION STAR

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:  UNION STAR, KY

DATE OF BURIAL:  1/30/1912

19.   UNDERTAKER:  D.S. RICHARDSON

ADDRESS:  UNION STAR

 

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Copyright.  All rights reserved.
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