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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:  BIG SPRING

Inc Town:  NEAR BIG SPRING

City:  

No.  

St.  

Ward:  

Registration District No.:  5314

Primary Registration District No:  14

File No.  24221

Registered No: 10

2.       FULL NAME:  AMMONS, MAGGIE WHITLER

PERSONAL AND STATISTICAL PARTICULARS

3.       SEX:     FEMALE

4.       COLOR OR RACE:  WHITE

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

6.       DATE OF BIRTH: DON’T KNOW - 1860

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  52 YRS

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWIFE

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

9.       BIRTHPLACE:  KY

10.   NAME OF FATHER:  ALLEN WHITLER

11.   BIRTHPLACE OF FATHER:  BRECKINRIDGE CO, KY

12.   MAIDEN NAME OF MOTHER:  POLLY HAYNES

13.   BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO, KY

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

(Informant)  JAS HUFFINES

(Address)  BIG SPRING, KY

15.   Filed  OCT 15, 1912

REGISTAR:  J.L. MORRIS

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  OCT 14, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  JUL 19, 1912 to OCT 14, 1912

That I last saw him/her alive on (date):  OCT 2, 1912

And that death occurred on the date stated above at (time AM/PM):  12:- -  AM

THE CAUSE OF DEATH was as follows:  CARCINOMA OF LIVER

 

(Duration)   Years:            Months:     6       Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  C.B. WITT

Date:  OCT 14, 1912

Address:  BIG SPRING, 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:  BLUFORD STILL CEM

DATE OF BURIAL:  OCT 14, 1912

20.   UNDERTAKER:  R.D. PENICK

ADDRESS:  BIG SPRING, KY

 
 

 

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