************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HARDINSBURG Inc Town: City: No. St. Ward: 4 Registration District No.: 130 Primary Registration District No: 5384 File No. 17895 Registered No: 2. FULL NAME: BEAR, ELIZA PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: 1861 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 52 YR 8. OCCUPATION (a.) Trade, profession or particular kind of work: DAY WORK (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KY 10. NAME OF FATHER: BEAR 11. BIRTHPLACE OF FATHER: KY 12. MAIDEN NAME OF MOTHER: LIDE BEAR 13. BIRTHPLACE OF MOTHER: KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) (Address) 15. Filed JULY 24, 1913 REGISTAR: W. B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JULY 23, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): JUNE, 1912 That I last saw him/her alive on (date): JULY 21, 1913 And that death occurred on the date stated above at (time AM/PM): 8 AM THE CAUSE OF DEATH was as follows: LARYNGEAL TUBERCULOSIS (Duration) Years: 1 Months: 1 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): JOHN E. KINCHELOE Date: JULY 23, 1913 Address: 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: COUNTY POOR HOUSE DATE OF BURIAL: JULY 24, 1913 20. UNDERTAKER: B. F. BEARD & CO. ADDRESS: HARDINSBURG, KY ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************