************************************************************************ 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.: HARDINSBURG Inc Town: City: No. St. Ward: 1st Registration District No.: 130 Primary Registration District No: 5301 File No. 23818 Registered No: 2. FULL NAME: BROWN, ANTHONY PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: MAR 16, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 1 / 8 / 12 8. OCCUPATION (a.) Trade, profession or particular kind of work: INFANT (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: JOE BROWN 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: KATE MATTINGLY 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) WILLIAM DAVIS (Address) McQUADY 15. Filed OCT 29, 1915 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: OCT 28, 1915 17. I HEREBY CERTIFY, That I attended deceased from (date): OCT 27, 1915 tO OCT 28, 1915 That I last saw him/her alive on (date): OCT 27, 1915 And that death occurred on the date stated above at (time AM/PM): 4 AM THE CAUSE OF DEATH was as follows: ENTEROCOLITIS (Duration) Years: Months: Days: 7 Contributory: (Duration) Years: Months: Days: Signed (M.D.): JOHN E. KINCHELOE Date: OCT 28, 1915 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: McQUADY CEM DATE OF BURIAL: OCT 29, 1915 20. UNDERTAKER: E.F. LYONS ADDRESS: McQUADY 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 ************************************************************************