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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.:  Hardinsburg

Inc Town:  Hardinsburg

City:  

No.  

St.  

Ward:  1

Registration District No.:  

Primary Registration District No:  5301

File No.  20117

Registered No:  51

2.       FULL NAME:  Clayton L. Beard

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  Male

4.       COLOR OR RACE:  White

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

6.       DATE OF BIRTH:  August 15, 1843

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  78 years, 0 months, 2 days

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

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

9.       BIRTHPLACE:  Kentucky

10.   NAME OF FATHER:  Joel Beard

11.   BIRTHPLACE OF FATHER:  Kentucky

12.   MAIDEN NAME OF MOTHER:  Muffet

13.   BIRTHPLACE OF MOTHER:  Kentucky

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

(Informant)  C.W. Histon

(Address)  Hardinsburg

15.   Filed  Aug 18, 1911

REGISTAR:  W. B. Lennon

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Aug 17, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Aug 12, 1911 to Aug 17, 1911

That I last saw him/her alive on (date):  Aug 17, 1911

And that death occurred on the date stated above at (time AM/PM):  7 P.M.

THE CAUSE OF DEATH was as follows:  Apoplexy

 

(Duration)   Years:            Months:            Days:  2

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  Jno E. Kincheloe

Date:  Aug 17, 1911

Address:  Hardinsburg

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:  Hardinsburg Cemetery

DATE OF BURIAL:  Aug 18, 1911

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

ADDRESS:  Hardinsburg


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Copyright.  All rights reserved.
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