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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 County

Vot. Pol.: Rockvale

Inc Town:

City:

No.

St.

Ward

Registration District No.: 132

Primary Registration District No: 5320

File No. 30580

Registered No: 

2.       FULL NAME: Sarah Jane Awbrey

PERSONAL AND STATICAL PARTICULARS

3.       SEX: female

4.       COLOR OR RACE: white

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

6.       DATE OF BIRTH: Dec 4, 1845

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 66 yrs, 4 mo

8.       OCCUPATION (a.) Trade, profession or particular kind of work: House Keeper

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

9.       BIRTHPLACE: Hardin Co., KY

10.   NAME OF FATHER: Don't Know

11.   BIRTHPLACE OF FATHER: Don't Know

12.   MAIDEN NAME OF MOTHER: Don't Know

13.   BIRTHPLACE OF MOTHER: Don't Know

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

(Informant) Thos L McCarty

(Address) Rockvale, KY

15.   Filed Jan 8, 1912

REGISTAR: E.L. Robertson

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: Dec 8, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date): Dec 3, 1911 to Dec 8, 1911

That I last saw him/her alive on (date): Dec 7, 1911

And that death occurred on the date stated above at (time AM/PM): 3:30 pm

THE CAUSE OF DEATH was as follows: Paralysis

 

(Duration)

Years:

Months:

Days:

Signed (M.D.): E.P. Rodgers

Date: Dec 8, 1911

Address: Fordsville, 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 Macedonia Graveyard

DATE OF BURIAL: Dec 9, 1911

20.   UNDERTAKER: Thos L. McCarty

ADDRESS: Rockvale, KY

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Copyright.  All rights reserved.
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