************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: STEPHENSPORT Inc Town: City: No. St. Ward: Registration District No.: 5308 Primary Registration District No: File No. 11704 Registered No: 76 2. FULL NAME: ARMSTRONG, JAMES PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: SEP 19, 1850 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 64 / 8 / - 8. OCCUPATION (a.) Trade, profession or particular kind of work: SECTION HAND ON RAILROAD [when employed] (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: DAVIESS COUNTY 10. NAME OF FATHER: DAVID ARMSTRONG 11. BIRTHPLACE OF FATHER: VIRGINIA 12. MAIDEN NAME OF MOTHER: NOT LISTED 13. BIRTHPLACE OF MOTHER: NOT LISTED 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) FLOYD ARMSTRONG (Address) SAMPLE 15. Filed MAY 20, 1915 REGISTAR: R.A. SHELLMAN MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: MAY 19, 1915 17. I HEREBY CERTIFY, That I attended deceased from (date): FEB 12, 1915 to APR 18, 1915 That I last saw him/her alive on (date): APR 18, 1915 And that death occurred on the date stated above at (time AM/PM): 7 AM THE CAUSE OF DEATH was as follows: CARCINOMA OF STOMACH (Duration) Years: Months: 11 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): WILLIAM L. MILNER Date: MAY 19, 1915 Address: UNION STAR 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: SAMPLE DATE OF BURIAL: MAY 21, 1915 20. UNDERTAKER: C.A. TINIUS ADDRESS: STEPHENSPORT 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 ************************************************************************