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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: Breckenridge

Vot. Pol.: Hardinsburg

Inc Town:

City:

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 6176

Registered No: 14

2.       FULL NAME: Raymond Butler

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:

6.       DATE OF BIRTH: Feb 25, 1912

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 15 da

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

(b.)  General nature of industry business or establishment which employed: With parents

9.       BIRTHPLACE: Lost Hill Breckinridge Co KY

10.   NAME OF FATHER: Murray Butler

11.   BIRTHPLACE OF FATHER: Locust Hill Breck Co, KY

12.   MAIDEN NAME OF MOTHER: Emaline Butler

13.   BIRTHPLACE OF MOTHER: Locust Hill Breck Co, KY

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

(Informant) Haden Butler

(Address) Locust Hill KY

15.   Filed March 12, 1912

REGISTAR: V E Goodman

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: Mar 10, 1912 

17.   I HEREBY CERTIFY, That I attended deceased from (date): Feb 25, 1912 to Mar 10, 1912

That I last saw him/her alive on (date): Mar 10, 1912

And that death occurred on the date stated above at (time AM/PM): 12 AM

THE CAUSE OF DEATH was as follows: Congenital Dability

 

(Duration)

Years:

Months:

Days: 15

Signed (M.D.): J A Sandbach

Date: Mar 10, 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 Turpen Grave

DATE OF BURIAL: Mar 11, 1912

20.   UNDERTAKER: Bill Buttler

ADDRESS: Locust Hill


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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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