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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 County

Vot. Pol.:  

Inc Town:  Near Glen Dean

City:  

No.  

St.  

Ward:  

Registration District No.:  132

Primary Registration District No:  5319

File No.  30578

Registered No:  

2.       FULL NAME:  Edd Briscoe Baxter

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  Male

4.       COLOR OR RACE:  White

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

6.       DATE OF BIRTH:  Jan 4, 1837

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  74 Years, 11 months, 4 days

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

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

9.       BIRTHPLACE:  Marion County, KY

10.   NAME OF FATHER:  William Baxter

11.   BIRTHPLACE OF FATHER:  Boil County, KY

12.   MAIDEN NAME OF MOTHER:  Elizabeth Briscoe

13.   BIRTHPLACE OF MOTHER:  Boil County, KY

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

(Informant)  Mrs. E.B. Baxter

(Address)  Glen Dean

15.   Filed  Jan 2, 1912

REGISTAR:  E.L. Robertson

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Dec 11, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date):  July 1, 1911 to Sept 4, 1911

That I last saw him/her alive on (date):  Sept 8, 1911

And that death occurred on the date stated above at (time AM/PM):  5 P.M.

THE CAUSE OF DEATH was as follows:  Brights Disease

 

(Duration)   Years:            Months:      5      Days:  9

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  R.T. Dempster

Date:  Dec 20, 1911

Address:  Glen Dean

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:  Goshen Burial Ground

DATE OF BURIAL:  Dec 12, 1911

20.   UNDERTAKER:  Wilson Owen & Co.

ADDRESS:  Glen Dean



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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************