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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.:  5307
Inc Town:  
City:  CLOVERPORT, KY
No.  
St.  
Ward:  3
Registration District No.:  
Primary Registration District No:  
File No.  28695
Registered No:  131
2. FULL NAME:  NARSIS S. CAMPBELL
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6. DATE OF BIRTH:  JAN. 22, 1837
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  76 YR 9MO 15 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed: HOUSEWORK  
9. BIRTHPLACE:  ARKANSAS
10. NAME OF FATHER:  WM. CAMBELL
11. BIRTHPLACE OF FATHER:  VAGINIA
12. MAIDEN NAME OF MOTHER:  DON’T KNOW
13. BIRTHPLACE OF MOTHER:  DON’T KNOW
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  LEW L. CAMPBELL
(Address)  CLOVERPORT
15. Filed  NOV 18  1913
REGISTAR:  JLMOTTO
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  11  17  1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  Nov 15 1913 TO NOV 17- 1913
That I last saw him/her alive on (date):  HER  NOV 11TH 1913
And that death occurred on the date stated above at (time AM/PM):  7:30 A 
THE CAUSE OF DEATH was as follows:  PNEUMONIA FEVER
 
(Duration)   Years:            Months:            Days: 2
Contributory:   SENILITY
 
(Duration)   Years:     15       Months:            Days:   
Signed (M.D.):  F. R. LIGHTFOOT
Date:   NOV 18, 1913
Address:  CLOVERPORT, 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:  HANCOCK CO. KY
DATE OF BURIAL:  NOV 18, 1913
20. UNDERTAKER:  M. HAMMAN SONS
ADDRESS:  CLOVERPORT KY
 

ADDITIONAL COMMENTS/NOTES:


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