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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BEWLEYVILLE
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5313
Primary Registration District No:  
File No.  20321
Registered No: 7 
2.	FULL NAME:  BROWN, MYRTLE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  COLORED
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  DEC 15, 1895
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  18 / 8 / -
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  AT HOME
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER:  JAMES BROWN
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE
12.	MAIDEN NAME OF MOTHER:  MATILDA STARKS
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  NOT LISTED
(Address)  
15.	Filed  AUG 15, 1914
REGISTAR:  JOHN COMPTON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: AUG 14, 1914 
17.	I HEREBY CERTIFY, That I attended deceased from (date):  AUG 10, 1914 to AUG 12, 1914
That I last saw him/her alive on (date):  AUG 12, 1914
And that death occurred on the date stated above at (time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS OF LUNGS
(Duration)   Years:            Months:      4      Days:    2
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A.W. FOOTE
Date:  AUG 14, 1914
Address:  RFD #1, IRVINGTON
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:  NOT LISTED
DATE OF BURIAL:  
20.	UNDERTAKER:  
ADDRESS:  


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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