************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDTGE Vot. Pol.: HUDSON Inc Town: City: No. St. Ward: Registration District No.: Primary Registration District No: 5316 File No. 28701 Registered No: 8 2. FULL NAME: ALLEN, NINA MAY PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: NOV 7, 1913 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 6 HRS 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: LANNIE ALLEN 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: ELDORA GOLDSMITH 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) LANNIE ALLEN (Address) EVELEIGH, KY [GRAYSON CO] 15. Filed NOV 9, 1913 REGISTAR: J.H. COMER MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: NOV 8, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): NOV 7, 1913 to NOV 8, 1913 That I last saw him/her alive on (date): NOV 8, 1913 And that death occurred on the date stated above at (time AM/PM): 8 AM THE CAUSE OF DEATH was as follows: PREMATURE BIRTH (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.G. HALE Date: HARDIN SPRINGS Address: 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: ALLEN CEM DATE OF BURIAL: NOV 9, 1913 20. UNDERTAKER: ADDRESS: ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************