************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: UNION STAR Inc Town: City: No. St. Ward: Registration District No.: 5309 Primary Registration District No: File No. 25214 Registered No: 2. FULL NAME: BARGER [STILLBORN] PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: OCT 10, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: BRECKINRIDGE CO., KY 10. NAME OF FATHER: W. W. BARGER 11. BIRTHPLACE OF FATHER: BRECKINRIDGE CO., KY 12. MAIDEN NAME OF MOTHER: CORA OWENS 13. BIRTHPLACE OF MOTHER: BRECKINRIDGE CO., KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) W. W. BARGER (Address) [UNREADABLE] 15. Filed OCT 11, 1914 REGISTRAR: LEE STEWART MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: OCT 10, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): OCT 10, 1914 That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: STRANGULATION (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): WILLIAM L. MILNER Date: OCT 10, 1914 Address: UNION STAR, 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: BRUNER BURYING GROUND DATE OF BURIAL: OCT 11, 1914 20. UNDERTAKER: C. A. TINIUS ADDRESS: STEPHENSPORT, KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************