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1.	PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Stephensport
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  3196
Registered No:  
2.	FULL NAME:  Garland Brumfield
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  Feby 24, 1911
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 yrs 11 mos 5 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Breckenridge Co.
10.	NAME OF FATHER:  Morton Brumfield
11.	BIRTHPLACE OF FATHER:  Breckenridge Co
12.	MAIDEN NAME OF MOTHER:  Grace Dowell
13.	BIRTHPLACE OF MOTHER:  Breckenridge Co
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mort Brumfield
(Address)  Sample
15.	Filed:  Jan 25, 1913
REGISTAR:  R. A. Shellman
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Jany 29, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Jany 23, 1913 to Jany 28, 1913
That I last saw him alive on (date):  Jany 28
And that death occurred on the date stated above at (time AM/PM):  2 AM
THE CAUSE OF DEATH was as follows:  convulsions

(Duration)   Years:            Months:            Days:  
Contributory:  Burn

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Wm L. Milner
Date:  1/29, 1913
Address:  Union Star
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:  Sample
DATE OF BURIAL:  Jan 29, 1913
20.	UNDERTAKER:  W. J. Schopp
ADDRESS:  Stephensport


ADDITIONAL COMMENTS/NOTES:




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