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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.:  5305
Inc Town:  Cloverport
City:  
No.  
St.  
Ward:  1
Registration District No.:  
Primary Registration District No:  
File No.  19020
Registered No: 70 
2. FULL NAME:  Berry, James N.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  May 1, 1848
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  64 yr 3 mo 5 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Cooper
(b.)  General nature of industry business or establishment which employed:  Barrel making
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  Thomas Berry
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Unknown
13. BIRTHPLACE OF MOTHER:  Unknown
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. George Wells 
(Address)  Owensboro, KY
15. Filed  Aug. 6, 1912
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Aug. 6, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Aug. 6, 1912
That I last saw him/her alive on (date):  Aug. 6, 1912
And that death occurred on the date stated above at (time AM/PM):  11:30 AM
THE CAUSE OF DEATH was as follows:  Apoplexy

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. R. Lightfoot
Date:  Aug. 6, 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:  Owensboro, KY
DATE OF BURIAL:  Aug. 7, 1912
20. UNDERTAKER:  M. Hamman Sons
ADDRESS:  Cloverport, KY

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Copyright.  All rights reserved.
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