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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.        PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pol.:  STEPHENSPORT

Inc Town:  

City:  STEPHENSPORT

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  254

Registered No:  8

2.        FULL NAME:  BELL, PHILIP SCOTT

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  MALE

4.        COLOR OR RACE:  WHITE

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

6.        DATE OF BIRTH:  AUG 25, 1862

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  48 / 4 / 9

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

(b.)  General nature of industry business or establishment which employed:  GEN’L MERCHANDISE STORE

9.        BIRTHPLACE:  HARDINSBURG

10.     NAME OF FATHER:  NAPOLEON BELL

11.     BIRTHPLACE OF FATHER:  GRAYSON CO, KY

12.     MAIDEN NAME OF MOTHER:  NANCY KENNEDY

13.     BIRTHPLACE OF MOTHER:  GRAYSON CO, KY

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

(Informant)  MRS. P.S. BELL

(Address)  STEPHENSPORT

15.     Filed  JAN 4, 1911

REGISTAR:  R.A. SHELLMAN

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  JAN 3, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  NOV 15, 1910 to JAN 3, 1911

That I last saw him/her alive on (date):  JAN 3, 1911

And that death occurred on the date stated above at (time AM/PM):  10 AM

THE CAUSE OF DEATH was as follows:  STRICTURE OF ESOPHAGUS AT OPENING TO STOMACH

 

(Duration)   Years:            Months:      1      Days:  18

Contributory:  EXHAUSTION

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  P.H. NEVITT

Date:  JAN 4, 1911

Address:  STEPHENSPORT

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:  STEPHENSPORT

DATE OF BURIAL:  JAN 4, 1911

20.     UNDERTAKER:  W.J. SCHOPP

ADDRESS:  STEPHENSPORT

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