************************************************************************ 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. 21284 Registered No: 2. FULL NAME: BROWN, JULEA PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: DEC 20, 1874 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 40 / 9 / 7 8. OCCUPATION (a.) Trade, profession or particular kind of work: HOUSEKEEPING (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: INDIANA 10. NAME OF FATHER: MICHAEL BROWN 11. BIRTHPLACE OF FATHER: INDIANA 12. MAIDEN NAME OF MOTHER: "SAID SHE WAS KIDNAPPED" 13. BIRTHPLACE OF MOTHER: DON'T KNOW 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) JULIA BROWN (Address) 15. Filed SEP 28, 1915 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: SEP 27, 1915 17. I HEREBY CERTIFY, That I attended deceased from (date): SEP 27, 1915 to SEP 27, 1915 That I last saw him/her alive on (date): SEP 27, 1915 And that death occurred on the date stated above at (time AM/PM): 10 PM THE CAUSE OF DEATH was as follows: RAT PASTE WITH SUICIDAL INTENTIONS (Duration) Years: Months: Days: 4 Contributory: (Duration) Years: Months: Days: Signed (M.D.): JOHN E. KINCHELOE Date: SEP 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: MOORMAN GRAVEYARD DATE OF BURIAL: SEP 28, 1915 20. UNDERTAKER: J.T. HOBEN ADDRESS: HARDINSBURG 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 ************************************************************************