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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1.       PLACE OF DEATH

County: Breckinridge

Vot. Pol.: Hardinsburg

Inc Town:

City:

No.

St. 1

Ward

Registration District No.: 130

Primary Registration District No: 5301

File No.8806

Registered No: 17

2.       FULL NAME: Mary Francis Ball

PERSONAL AND STATICAL PARTICULARS

3.       SEX: female

4.       COLOR OR RACE: white

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

6.       DATE OF BIRTH: Oct 10, 1864

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 46 years, 4 mo, 21 days

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

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

9.       BIRTHPLACE: Breckinridge County, KY

10.   NAME OF FATHER: William Furrow

11.   BIRTHPLACE OF FATHER: Virginia

12.   MAIDEN NAME OF MOTHER: not known

13.   BIRTHPLACE OF MOTHER: Virginia

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

(Informant) Pearl Jackson (Deceased Daughter)

(Address) McQuady

15.   Filed 4/2, 1911

REGISTAR: W. B. Lennon

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: April 1, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date): Feb 15, 1911 to April 1, 1911

That I last saw him/her alive on (date): April 1, 1911

And that death occurred on the date stated above at (time AM/PM): 10 am

THE CAUSE OF DEATH was as follows: Tuberculosis of the Lungs - Phthisis Pulmonalis

 

(Duration)

Years: 10

Months: 15

Days:

Signed (M.D.): D. H. Lucas

Date: Apr 1, 1911

Address: McQuady, KY

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

At place of death (yr, mo, da.): 15 years, 9 months, 7 days

In the State (yr, mo, da):

Where was disease contracted,  if not at place of death? McQuady, KY

Former or usual residence: Breckinridge County, KY

19.   PLACE OF BURIAL OR REMOVAL McQuady

DATE OF BURIAL: April 2, 1911

20.   UNDERTAKER: E. F. Lyons

ADDRESS: McQuady

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Copyright.  All rights reserved.
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