(AREA FOR NOTES TO DANA ABOUT TRANSCRIPTION)

Cause of death badly obscured


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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  UNION STAR, KY
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5309
File No.  3590
Registered No: 1  
2.	FULL NAME: BASHAM, VIRGIE LEE  
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  JUNE 23, 1902
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  10 YR 7 MO 21 DA
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:  GEORGE BASHAM
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  SALLIE DOWELL
13.	BIRTHPLACE OF MOTHER:  KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  GEORGE E. SHIVELY
(Address)  STEPHENSPORT, KY
15.	Filed  MARCH 4, 1913  
REGISTAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  FEB 14, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  FEB 10, 1913
That I last saw him/her alive on (date):  FEB 14, 1913
And that death occurred on the date stated above at (time AM/PM):  10 PM
THE CAUSE OF DEATH was as follows:  MEMBRANEOUS(?) COUGH

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  GEORGE E. SHIVELY
Date:  FEB 14, 1913
Address:  STEPHENSPORT, 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:  SAMPLE, KY
DATE OF BURIAL:  FEB. 15, 1913
20.	UNDERTAKER:  W. J. SCHOPP
ADDRESS:  STEPHENSPORT, KY


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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