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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.:  Ball Town #21
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5321
Primary Registration District No:  
File No.  6190
Registered No:  2
2. FULL NAME:  Beavin, Chester B.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Oct. 22, 1873
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  38 yr 5 mo 10 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  James Beavin
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Rhoda Burdette
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  F. G. Whitehouse
(Address)  Mattingly, KY
15. Filed  Apr. 3, 1912
REGISTAR:  Fred Frank
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Mar. 31, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 1912
That I last saw him/her alive on (date):  Feb. 18, 1912
And that death occurred on the date stated above at (time AM/PM):  10 AM
THE CAUSE OF DEATH was as follows:  Tuberculosis (Pulmonary)

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

(Duration)   Years:    3        Months:            Days:  
Signed (M.D.):  A. A. Simons
Date:  March 31, 1912
Address:  Cloverport, 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:  McQuady, KY
DATE OF BURIAL:  Apr. 1, 1912
20. UNDERTAKER:  M. Hamman & Son
ADDRESS:  Cloverport, KY

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Copyright.  All rights reserved.
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