1.       PLACE OF DEATH

County:    BRECKINRIDGE

Vot. Pol.:  HARDINSBURG

Inc Town:  HARDINSBURG

City:  

No.  

St.  

Ward  4TH

Registration District No.:  

Primary Registration District No:  

File No.   250

Registered No:  6

2.       FULL NAME:  ASKINS, ANDREW

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  MALE

4.       COLOR OR RACE:  BLACK

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

6.       DATE OF BIRTH:  DON’T KNOW 1833

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):   78 YRS

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

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

9.       BIRTHPLACE:  KENTUCKY

10.   NAME OF FATHER:  PHILLIP ASKINS

11.   BIRTHPLACE OF FATHER:  KENTUCKY

12.   MAIDEN NAME OF MOTHER:  SALLIE ASKINS

13.   BIRTHPLACE OF MOTHER:  KENTUKCY

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

(Informant)  CHARLES MATTINGLY

(Address)  HARDINSBURG

15.   Filed  JAN 29, 1911

REGISTAR:  W.B. LENNON

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  JAN 29, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date):  OCT 1, 1910 to JAN 29, 1911

That I last saw him/her alive on (date):  JAN 26, 1911

And that death occurred on the date stated above at (time AM/PM):  2 AM

THE CAUSE OF DEATH was as follows:  CHRONIC INTERSTITIAL NEPHRITIS

 

(Duration)  

Years:   3

Months:  

Days:  

Signed (M.D.):  JOHN E. KINCHELOR

Date:  JAN 29, 1911

Address:  HARDINSBURG

18.   LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)

At place of death (yr, mo, da.):   0 / 3 / 29

In the State (yr, mo, da):  ALL OF LIFE

Where was disease contracted,  if not at place of death?  MC QUADY

Former or usual residence:  MC QUADY 

19.   PLACE OF BURIAL OR REMOVAL  PAUPER CEMETERY

DATE OF BURIAL:  JAN 29, 1911

20.   UNDERTAKER:  B.F. BEARD & CO

ADDRESS:  HARDINSBURG

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