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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.:  Hardinsburg

Inc Town:  

City:  

No.  

St.  

Ward:  3

Registration District No.:  130

Primary Registration District No:  5303

File No.  14339

Registered No:  122

2.       FULL NAME:  James S. Barnes

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  male

4.       COLOR OR RACE:  white

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

6.       DATE OF BIRTH:  Nov 11, 1837

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  78 years, 7 months, 26 days

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

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

9.       BIRTHPLACE:  KY

10.   NAME OF FATHER:  James Barnes

11.   BIRTHPLACE OF FATHER:  Indiana

12.   MAIDEN NAME OF MOTHER:  Mary Thompson

13.   BIRTHPLACE OF MOTHER:  Scotland

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

(Informant)  Mary Barnes

(Address)  Hardinsburg

15.   Filed  June 21, 1912

REGISTAR:  W.B. Lennon

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  June 20, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  June 1911 to June 20, 1912

That I last saw him/her alive on (date):  June 16, 1912

And that death occurred on the date stated above at (time AM/PM):  1 p.m.

THE CAUSE OF DEATH was as follows:  Sarcoma Inferior Maxillary

 

(Duration)   Years:            Months:            Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.): Jno. E Kincheloe, MD

Date:  Jun 21, 1912

Address:  Hardinsburg, 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:  Hardinsburg Cemetery

DATE OF BURIAL:  June 21, 1912

20.   UNDERTAKER:  B.F. Beard & Co.

ADDRESS:  Hardinsburg, KY



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