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1.	PLACE OF DEATH
County:  		BRECKINRIDGE
Vot. Pol.:  CLOVERPORT
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  131
Primary Registration District No:  5301
File No.  26155
Registered No:  
2.	FULL NAME:  BATES, GEORGE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  BLACK
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  APRIL 2, 1884
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  DAY LABORER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KY
10.	NAME OF FATHER:  ELIJAH BATES
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  MARGARET COLLIER
13.	BIRTHPLACE OF MOTHER:  KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  OLA BATES
(Address)  CLOVERPORT
15.	Filed  OCT 24, 1913
REGISTAR:  W. B. LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 26, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  OCT 19, 1913
That I last saw him/her alive on (date):  OCT 25, 1913
And that death occurred on the date stated above at (tIme AM/PM):  
THE CAUSE OF DEATH was as follows:  ABSCESS LIVER

(Duration)   Years:            Months:   2        Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  JOHN E. KINCHELOE
Date:  OCT 26, 1913
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:  CLOVERPORT, KY
DATE OF BURIAL:  OCT 27, 1913
20.	UNDERTAKER:  M. HAMMAN & SONS
ADDRESS:  CLOVERPORT, KY


ADDITIONAL COMMENTS/NOTES:




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