************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: Breckenridge Vot. Pol.: Hardinsburg Inc Town: City: No. St. Ward: Registration District No.: 130 Primary Registration District No: 5302 File No. 20304 Registered No: 2. FULL NAME: Henry A. Butler PERSONAL AND STATICAL PARTICULARS 3. SEX: male 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single 6. DATE OF BIRTH: Aug 20, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 8. OCCUPATION (a.) Trade, profession or particular kind of work: Infant (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Forest Hill, Breckenridge County, Ky 10. NAME OF FATHER: Ezra Butler 11. BIRTHPLACE OF FATHER: Forest Hill, Breckenridge Co., Ky 12. MAIDEN NAME OF MOTHER: Mary C. Butler 13. BIRTHPLACE OF MOTHER: Locust Hill, Breck C., Ky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Murray Butler (Address) Forest Hill 15. Filed Aug 21, 1914 REGISTAR: W. B. Lennon MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: August 20, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): August 20, 1914 And that death occurred on the date stated above at (time AM/PM): 5 AM THE CAUSE OF DEATH was as follows: [unreadable] - congenital (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J. A. Sandbach Date: August 20, 1914 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: Turpin Cemetery DATE OF BURIAL: August 21, 1914 20. UNDERTAKER: Coffin made at home ADDRESS: ADDITIONAL COMMENTS/NOTES: ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************