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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
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  26164
Registered No:  60
2. FULL NAME:  NORA AGNEY BUTLER
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FE
4. COLOR OR RACE:  W 
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  5  1   1913
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 YR 5 MO 18 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  NONE
(b.)  General nature of industry business or establishment which employed:  NONE
9. BIRTHPLACE:  KENTUCKY
10. NAME OF FATHER:  C. A. BUTLER
11. BIRTHPLACE OF FATHER:  BURAS KY
12. MAIDEN NAME OF MOTHER:  CARMAN
13. BIRTHPLACE OF MOTHER:  KENTUCKY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C.A. BUTLER
(Address)  CONSTANTINE
15. Filed  OCT. 13  1913
REGISTAR:  J. S. MITCHAM
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  11  17  1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  10-13 1913 TO 11-17- 1913
That I last saw him/her alive on (date):  ALIVE 11-17- 1913
And that death occurred on the date stated above at (time AM/PM):   
THE CAUSE OF DEATH was as follows:  URAEMIA
 
(Duration)   Years:            Months:            Days: 7
Contributory:   NEPHRITIS
 
(Duration)   Years:            Months:            Days:  7
Signed (M.D.):  S STULL
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:  ROBERT BUTLER BGROUND
DATE OF BURIAL:  OCT 19, 1913
20. UNDERTAKER:  ALF TAYLOR
ADDRESS:  CUSTER KY

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Copyright.  All rights reserved.
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