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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.:  Hudson 
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5311
Primary Registration District No:  
File No.  265
Registered No:  1
2. FULL NAME:  Arlingrist, Louviney
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  Caucasian
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  June 12, 1831
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  79 yr 6 mo 27 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky	
10. NAME OF FATHER:  Hudson, James
11. BIRTHPLACE OF FATHER:  Unknown
12. MAIDEN NAME OF MOTHER:  Margaret
13. BIRTHPLACE OF MOTHER:  Unknown
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Moses Jackson
(Address)  Hudson, KY
15. Filed  Jan. 11, 1911
REGISTAR:  J. H. Conner
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Jan. 9, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  Heart failure caused by rheumatism

(Duration)   Years:            Months:            Days:  
Contributory:  Rheumatism

(Duration)   Years:      10      Months:            Days:  
Signed (M.D.):  T. J. Hall
Date:  Jan. 11, 1911
Address:  Constantine, 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:  Hanson Burial Ground
DATE OF BURIAL:  Jan. 11, 1911
20. UNDERTAKER:  J. R. Stone
ADDRESS:  Hardin Springs, KY

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Copyright.  All rights reserved.
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