************************************************************************ 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.: Inc Town: Frymire, KY City: No. 10 St. Ward: Registration District No.: 5310 Primary Registration District No: File No. 3322 Registered No: 5310 2. FULL NAME: Chas. M. Brown PERSONAL AND STATICAL PARTICULARS 3. SEX: male 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single 6. DATE OF BIRTH: Jan 1, 1882 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): about 30 yrs. 1 mo. 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farmer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Breckinridge Co, KY 10. NAME OF FATHER: J. W. Brown 11. BIRTHPLACE OF FATHER: Meade Co, KY 12. MAIDEN NAME OF MOTHER: Mary Avitt 13. BIRTHPLACE OF MOTHER: Breckinridge Co, KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Sam Hardesty (Address) Frymire, KY 15. Filed Feb. 6, 1912 REGISTAR: J. D. Cunningham Per Julie Cunningham MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Feby 3, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): 4 a.m. THE CAUSE OF DEATH was as follows: Tuberculosis tho ?????? when I saw him last (Duration) Years: about 2 Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J. Unreadable – probably J. B. Frymire Date: none Address: Frymire, 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: Union Star DATE OF BURIAL: Feb 5, 1912 20. UNDERTAKER: J. E. Ball ADDRESS: Andyville, KY (Meade County) ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************