************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: #12 Inc Town: IRVINGTON City: IRVINGTON No. St. Ward Registration District No.: Primary Registration District No: File No. 5312 Registered No: 6 2. FULL NAME: ARMS, SON PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: 6. DATE OF BIRTH: APR 30, 1911 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 14 HOURS 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: IRVINGTON, KY 10. NAME OF FATHER: ARMS, CLYDE 11. BIRTHPLACE OF FATHER: IRVINGTON 12. MAIDEN NAME OF MOTHER: CARSON, KATIE 13. BIRTHPLACE OF MOTHER: IRVINGTON 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) PIUS FACKLER (Address) IRVINGTON 15. Filed MAY 1, 1911 REGISTAR: J.W. HENRY MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: MAY 1, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): APR 30, 1911 to MAY 1, 1911 That I last saw him/her alive on (date): APR 30, 1911 And that death occurred on the date stated above at (time AM/PM): 2 AM THE CAUSE OF DEATH was as follows: PREMATURE BIRTH (Duration) Years: Months: Days: Signed (M.D.): S.P. PARKS Date: MAY 1, 1911 Address: IRVINGTON 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 DATE OF BURIAL: 20. UNDERTAKER: DAVE ALLEN ADDRESS: IRVINGTON ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************