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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Webster
Inc Town:  Webster
City:  
No.  
St.  
Ward:  
Registration District No.:  5311
Primary Registration District No:  
File No.  27045
Registered No:  
2. FULL NAME:  Beard, Henry Franklin
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Sept. 5, 1858
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  54 yr 1 mo 3 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Indiana
10. NAME OF FATHER:  Madison Beard
11. BIRTHPLACE OF FATHER:  Indiana
12. MAIDEN NAME OF MOTHER:  Unknown
13. BIRTHPLACE OF MOTHER:  Unknown
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Maude Beard
(Address)  Webster, KY
15. Filed  Nov. 12, 1912
REGISTAR:  H. Drane
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Nov. 9, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Oct. 20, 1912
That I last saw him/her alive on (date):  Nov. 9, 1912
And that death occurred on the date stated above at (time AM/PM):  3 AM
THE CAUSE OF DEATH was as follows:  Diabetes

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

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  T. J. Hendrick
Date:  Nov. 9, 1912
Address:  Webster, 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:  Walnut Grove
DATE OF BURIAL:  Nov. 12, 1912
20. UNDERTAKER:  G. T. Marshall
ADDRESS:  Irvington, KY

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Copyright.  All rights reserved.
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