************************************************************************
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.:  HARDINSBURG

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  130

Primary Registration District No:  5303

File No.  25005

Registered No: 62 

2.        FULL NAME:  BELL, NELLIE

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  FEMALE

4.        COLOR OR RACE:  WHITE

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

6.        DATE OF BIRTH:  AUG 25, 1881

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  30 / 1 / 19

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

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

9.        BIRTHPLACE:  KENTUCKY

10.     NAME OF FATHER:  NAPOLEON P. BELL

11.     BIRTHPLACE OF FATHER:  KENTUCKY

12.     MAIDEN NAME OF MOTHER:  NANCY KENNEDY

13.     BIRTHPLACE OF MOTHER:  KENTUCKY

14.     THE AB130OVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  JAMES DOWELL

(Address)  HARDINSBURG

15.     Filed  OCT 15, 1911

REGISTAR:  W.B. LENNON

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  OCT 14, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  AUG 31, 1911 to OCT 14, 1911

That I last saw him/her alive on (date):  OCT 12, 1911

And that death occurred on the date stated above at (time AM/PM):  6 AM

THE CAUSE OF DEATH was as follows:  CANCER OF STOMACH

 

(Duration)   Years:      2      Months:            Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  JOHN E. KINCHELOR

Date:  OCT 14, 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 CEM

DATE OF BURIAL:  OCT 15, 1911

20.     UNDERTAKER:  B.F. BEARD & CO

ADDRESS:  HARDINSBURG

 

TRANSCRIBER’S NOTE:  

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