************************************************************************
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.:  HUDSON
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5316
Primary Registration District No:  
File No.  26363
Registered No: 17 
2.	FULL NAME:  BUCKLER, VENNYE MILDRED
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  NOV 1, 1915
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  3 HRS  [BUT LISTED 3 DAYS ALSO]
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE: KENTUCKY 
10.	NAME OF FATHER:  J.H. BUCKLER
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MARTHA SHREWSBERRY
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J.H. BUCKER
(Address)  MADRID
15.	Filed  NOV 5, 1915
REGISTAR:  J.H. COMER
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 1, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV 1, 1915 to NOV 1, 1915
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  4 AM
THE CAUSE OF DEATH was as follows:  DEFECT OF TRACHEA
(Duration)   Years:            Months:            Days:    3
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S.J. HALL
Date:  
Address:  CONSTANTINE
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:  COYLES CEM
DATE OF BURIAL:  NOV 5, 1915
20.	UNDERTAKER:  
ADDRESS:  


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

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