************************************************************************
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.: 5307 
Inc Town:  CLOVERPORT
City:  
No.  
St.  
Ward:  3rd
Registration District No.:  131
Primary Registration District No:  5307
File No.  20313
Registered No: 164 
2.	FULL NAME:  BROWN, DAUGHTER
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  AUG 4, 1914
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  NEAR CLOVERPORT, BRECKINRIDGE COUNTY
10.	NAME OF FATHER:  JULIAN H. BROWN
11.	BIRTHPLACE OF FATHER:  MEADE COUNTY, KENTUCKY
12.	MAIDEN NAME OF MOTHER:  ELIZABETH MATTINGLY
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE COUNTY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  A.A. SIMMONS
(Address)  CLOVERPORT
15.	Filed  AUG 4, 1914
REGISTAR:  J.C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  AUG 4, 1914
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):  1 AM
THE CAUSE OF DEATH was as follows:  STILLBORN
(Duration)   Years:            Months:            Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A.A. SIMMONS
Date:  AUG 4, 1914
Address:  CLOVERPORT
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:  HARDINSBURG
DATE OF BURIAL:  AUG 4, 1914
20.	UNDERTAKER:  M. HAMMON & SONS
ADDRESS:  CLOVERPORT


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

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