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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, KY

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  130

Primary Registration District No:  5301

File No.  27034

Registered No:  130

2.       FULL NAME:  Mary Mabel Barnitz

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  female

4.       COLOR OR RACE:  white

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

6.       DATE OF BIRTH:  Dec 26, 1834

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  77 years, 11 months, 8 days

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

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

9.       BIRTHPLACE:  Christianburg, Tenn

10.   NAME OF FATHER:  William Barnitz

11.   BIRTHPLACE OF FATHER:  Christianburg, Tenn

12.   MAIDEN NAME OF MOTHER:  Elizabeth Barnitz

13.   BIRTHPLACE OF MOTHER:  Christiansburg, Tenn

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

(Informant)  Tho. H Wittier

(Address)  Hardinsburg, KY

15.   Filed  Nov 5, 1912

REGISTAR:  W.B. Lennon

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Nov 4, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Oct 31, 1912 to Nov 4, 1912

That I last saw him/her alive on (date):  Nov 3, 1912

And that death occurred on the date stated above at (time AM/PM):  4 1/2 a.m.

THE CAUSE OF DEATH was as follows:  Pulmonary Absc__ of ____ of Pneumonia two years ago

 

(Duration)   Years:            Months:            Days:  

Contributory:  Chronic  Nephrosis

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  A/M/ Kincheloe

Date:  Oct 5, 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:  Ivy Hill Cemetery

DATE OF BURIAL:  Nov 5, 1912

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

ADDRESS:  Hardinsburg, KY

 





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