************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************
1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Mooleyville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5310
Primary Registration District No:  
File No.  14069
Registered No: 14 
2. FULL NAME:  Beavin, Gertrud
PERSONAL AND STATICAL PARTICULARS
3. SEX: Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  Dec. 24, 1844
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., KY
10. NAME OF FATHER:  Lenard Beavin
11. BIRTHPLACE OF FATHER:  Maryland
12. MAIDEN NAME OF MOTHER:  Elizabeth Beavin
13. BIRTHPLACE OF MOTHER:  Maryland
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  L. D. Beavin
(Address)  Mooleyville, KY
15. Filed  May 24, 1912
REGISTAR:  J. D. Cunningham
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  May 23, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Apr. 18, 1912
That I last saw him/her alive on (date):  May 22, 1912
And that death occurred on the date stated above at (time AM/PM):  6 AM
THE CAUSE OF DEATH was as follows:  Chronic intestinal nephritis

(Duration)   Years:  about 2          Months:            Days:  
Contributory:  Chronic articular rheumatism

(Duration)   Years:  about 10          Months:            Days:  
Signed (M.D.):  D. S. Sphire
Date:  May 23, 1912
Address:  Mooleyville, 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:  St. Theresa
DATE OF BURIAL:  May 24, 1912
20. UNDERTAKER:  D. S. Richardson
ADDRESS:  Union Star, KY

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************