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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:  BRECK CO
Vot. Pol.:  UNION S DIV REG DIST 5039
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  31417
Registered No:  15
2. FULL NAME:  RICHARD MILNER BURTON
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  DEC 29 1913
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  9 HRS
8. OCCUPATION (a.) Trade, profession or particular kind of work:  NONE
(b.)  General nature of industry business or establishment which employed:  NONE
9. BIRTHPLACE:  BRECKINRIDGE CO KY
10. NAME OF FATHER:  J R BURTON
11. BIRTHPLACE OF FATHER:  RANDOLF CO MO
12. MAIDEN NAME OF MOTHER:  MARY P BEAUCHAMP
13. BIRTHPLACE OF MOTHER:  BRECK CO KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MRS W L ROBERTSON
(Address)  UNION STAR KY
15. Filed  DEC 30 1913
REGISTAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  DEC 30 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  DEC 29 1913 TO DEC 29 1913
That I last saw him/her alive on (date):  ALIVE DEC 29 1913
And that death occurred on the date stated above at (time AM/PM):  6 P
THE CAUSE OF DEATH was as follows:  PREMATURE
 
(Duration)   Years:            Months:            Days:  1
Contributory:  
 
(Duration)   Years:            Months:            Days:  1
Signed (M.D.):  WM L MILNER
Date:  12/20 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:  FAMILY GRAVE YARD
DATE OF BURIAL:  DEC 31 1913
20. UNDERTAKER:  W.L. ROBERTSON
ADDRESS:  UNION STAR KY
 

ADDITIONAL COMMENTS/NOTES:


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Copyright.  All rights reserved.
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