************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.
Registered No:  6319
2.	FULL NAME:  BOARD, JANERA
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  COLORED
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6.	DATE OF BIRTH:  AUG 10, 1913
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 / 0 / 8
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER: HENRY BOARD 
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE CO
12.	MAIDEN NAME OF MOTHER:  MANDA BELL
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  
(Address)  
15.	Filed  AUG 19, 1913
REGISTAR:  MRS. SUSAN JOLLY
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  AUG 18, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  AUG 14, 1914 to AUG 17, 1914
That I last saw him/her alive on (date):  AUG 17, 1914
And that death occurred on the date stated above at (Time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  PERITONITIS
(Duration)   Years:            Months:            Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E.A. LEX
Date:  AUG 8, 1914
Address: IRVINGTON
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:  IRVINGTON
DATE OF BURIAL:  AUG 19, 1914
20.	UNDERTAKER:  G.T. MARSHALL
ADDRESS:  IRVINGTON


ADDITIONAL COMMENTS/NOTES:




************************************************************************

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

************************************************************************