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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.:  8
Inc Town:  STEPHENSPORT, KY
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  12326
Registered No:  54
2.	FULL NAME:  JESSE ASKINS
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JULY 12, 1879
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  34 YR 10 MO 13 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KY
10.	NAME OF FATHER:  JOSEPH ASKINS
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  MARY BLAINE
13.	BIRTHPLACE OF MOTHER:  KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  CYE ASKINS
(Address)  STEPHENSPORT, KY
15.	Filed  MAY 31, 1914
REGISTRAR:  R. A. SHELLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 30, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  SEPT 2, 1913
That I last saw him/her alive on (date):  MAY 28, 1914
And that death occurred on the date stated above at (time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS

(Duration)   Years:      2      Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  GEORGE E. SHIVELY
Date:  JUNE 1, 1914
Address:  STEPHENSPORT, 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:  FAMILY BURYING GROUND
DATE OF BURIAL:  MAY 31, 1914
20.	UNDERTAKER:  C. A. TIMNIS
ADDRESS:  STEPHENSPORT, KY




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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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