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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.:  9

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5309

Primary Registration District No:  

File No.  8816

Registered No:  2

2.        FULL NAME:  CANARY, FRANCES ANNA DOWELL

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  FEMALE

4.        COLOR OR RACE:  WHITE

5.        SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED

6.        DATE OF BIRTH:  APR 4, 1833

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  78 / 0 / 6

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

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

9.        BIRTHPLACE:  BRECKINRIDGE

10.     NAME OF FATHER:  CLAYBORNE DOWELL

11.     BIRTHPLACE OF FATHER:  BRECKINRIDGE

12.     MAIDEN NAME OF MOTHER:  CAROLINE ROLLINS

13.     BIRTHPLACE OF MOTHER:  BRECKINRIDGE

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

(Informant)  R.B. HANKS

(Address)  AMMONS, KY

15.     Filed  APR 12, 1911

REGISTAR:  LEE STEWART

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  APR 10, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  

That I last saw him/her alive on (date):  

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

THE CAUSE OF DEATH was as follows:  RHEUMATISM BEGAN ABOUT MAY 1st 1910. HAS NOT BEEN ATTENDED BY ANY PHYSICIAN FOR TWO MONTHS OR MORE

 

(Duration)   Years:      1      Months:            Days:  

Contributory:  ATTENDING PHYSICIAN HAS MOVED FROM THIS COUNTY

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  WM L. MILNER, M.D. , CHAIRMAN

Date:  APR 11, 1911

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:  UNION STAR

DATE OF BURIAL:  APR 12, 1911

20.     UNDERTAKER:  W.J. SCHOPP

ADDRESS:  STEPHENSPORT

 

TRANSCRIBER’S NOTE:  


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