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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. Pol.:  5306
Inc Town:  
City:  Cloverport, Ky
No.  
St.  
Ward:  2
Registration District No.:  131
Primary Registration District No:  5306
File No.  22921
Registered No:  169
2. FULL NAME:  Eliza H. Allen
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  Oct 5, 1828
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  85 years, 11 months, 16 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  house keeper
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Joseph B. Oglesby
11. BIRTHPLACE OF FATHER:  Virginia
12. MAIDEN NAME OF MOTHER:  Rosie N. Coston
13. BIRTHPLACE OF MOTHER:  Maryland
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  E. B. Oglesby
(Address)  Cloverport, Ky
15. Filed  Sept 21, 1914
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Sept 21, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  Sept 1 to Sept 21, 1914
That I last saw him/her alive on (date):  Sept 20, 1914
And that death occurred on the date stated above at (time AM/PM):  12:30 AM
THE CAUSE OF DEATH was as follows:  Cancer Vagina etc.
 
(Duration) Years:            Months:            Days:  Don't Know
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. A. Simmons
Date:  Sept 22, 1914
Address:  Cloverport, Ky
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, Ky
DATE OF BURIAL:  Sept 21, 1914
20. UNDERTAKER:  M. Hammon & Son
ADDRESS:  Cloverport, Ky
 

ADDITIONAL COMMENTS/NOTES:
 



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Copyright.  All rights reserved.
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