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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.       PLACE OF DEATH

County: Breckinridge    

Vot. Pol.: Custer KY

Inc Town:

City:

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 434

Registered No:

2.       FULL NAME: Joel Penick Bruner

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married

6.       DATE OF BIRTH: July 20, 1890

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 21 yrs 5 mos 26 da

8.       OCCUPATION (a.) Trade, profession or particular kind of work: Farmer

(b.)  General nature of industry business or establishment which employed: Farm Work

9.       BIRTHPLACE: Garfield KY Breck KY

10.   NAME OF FATHER: William Bruner

11.   BIRTHPLACE OF FATHER: Garfield KY Breckinridge Co

12.   MAIDEN NAME OF MOTHER: Lillie Macy

13.   BIRTHPLACE OF MOTHER: Garfield KY Breck Co

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Lillie Bruner

(Address) Garfield KY

15.   Filed Jan 20, 1912

REGISTAR: R.O. Pennick

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: Jan 16, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Jan 4, 1912 to Jan 16, 1912

That I last saw him/her alive on (date): Jan 16, 1912

And that death occurred on the date stated above at (time AM/PM): 10 AM

THE CAUSE OF DEATH was as follows: Labor Pneumonia

 

(Duration) 

Years:

Months:

Days: 12

Contributory: None

Signed (M.D.): J.A. Sandbach

Date: Jan 16, 1912

Address: Garfield 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  Bruner Cemetary

DATE OF BURIAL: Jan 17, 1912

20.   UNDERTAKER: I. B. Richardson

ADDRESS: Garfield KY



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Copyright.  All rights reserved.
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