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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.:  5306

Inc Town:  

City:  CLOVERPORT     

No.  

St.  

Ward:  2nd

Registration District No.: 131  

Primary Registration District No:  5306

File No.  17188

Registered No: 27 

2.        FULL NAME:  BEAVIN, FRANK

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  MALE         

4.        COLOR OR RACE:  WHITE

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

6.        DATE OF BIRTH:  OCT 29, 1888

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  22 / 8 / 16

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

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

9.        BIRTHPLACE:  KENTUKCY

10.     NAME OF FATHER:  JOHN BEAVIN

11.     BIRTHPLACE OF FATHER:  KENTUCKY

12.     MAIDEN NAME OF MOTHER:  CATHERINE MILLER

13.     BIRTHPLACE OF MOTHER:  INDIANA

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

(Informant)  A.A. MILLER

(Address)  CLOVERPORT

15.     Filed  JUL 17, 1911

REGISTAR: J.C. NOLTE 

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  JUL 17, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  MAY 1, 1911 to JUL 7, 1911

That I last saw him/her alive on (date):  JUN 10, 1911

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

THE CAUSE OF DEATH was as follows:  TUBERCULOSIS

 

(Duration)   Years:            Months:      6      Days:  

Contributory:  EXPOSURE

 

(Duration)   Years:            Months:     6       Days:  

Signed (M.D.):  JAS T. OWEN

Date:  JUL 17, 1911

Address:  CLOVERPORT

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:  TAUL BURYING GROUND, BRECKINRIDGE COUNTY

DATE OF BURIAL:  JUL 17, 191

20.     UNDERTAKER:  M. HAMMON & SONS

ADDRESS:  CLOVERPORT

 

TRANSCRIBER’S NOTE:  
  

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