************************************************************************
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.: Balltown
Inc Town:
City:
No. 5321
St.
Ward
Registration District No.:
Primary Registration District No:
File No. 11584
Registered No: 3
2. FULL NAME: Infant Brown
PERSONAL AND STATICAL PARTICULARS
3. SEX: Male
4. COLOR OR RACE: white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
6. DATE OF BIRTH: May 13, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 30 minutes
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: Geo Brown
11. BIRTHPLACE OF FATHER: Kentucky
12. MAIDEN NAME OF MOTHER: Maggie Keenan
13. BIRTHPLACE OF MOTHER: Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Fred Matthews (?)
(Address) Free, Ky.
15. Filed May 15, 1911
REGISTAR: Fred Frank
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: May 13, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date): May 13, 1911 to May 13, 1911
That I last saw him/her alive on (date): May 13, 1911
And that death occurred on the date stated above at (time AM/PM): 8 PM
THE CAUSE OF DEATH was as follows:
Premature birth
(Duration)
Years:
Months:
Days:
Signed (M.D.): Wm Hounce
Date: May 13, 1911
Address: Mattingly, 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
DATE OF BURIAL: May 14, 1911
20. UNDERTAKER: M. Hammondson
ADDRESS: Cloverport, Ky.

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************