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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Custer
Inc Town:
City:
No.
St.
Ward
Registration District No.: 15
Primary Registration District No: 5315
File No. 19026
Registered No: 30
 FULL NAME: Feby Carman (Phebe)
PERSONAL AND STATICAL PARTICULARS
1. SEX: female
2. COLOR OR RACE: white
3. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
4. DATE OF BIRTH: March 1860
5. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 52yrs5mos
6. OCCUPATION (a.) Trade, profession or particular kind of work: house wife
(b.)  General nature of industry business or establishment which employed:
7. BIRTHPLACE: Breckinridge Co, Ky
8. NAME OF FATHER: Andy Carman
9. BIRTHPLACE OF FATHER: Ky
10. MAIDEN NAME OF MOTHER: Betsy Smith
11. BIRTHPLACE OF MOTHER: Ky
12. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) John Carman
(Address) Custer, Ky
13. Filed Aug 15, 1912
REGISTAR: R.O. Penick
MEDICAL CERTIFICATE OF DEATH
14. DATE OF DEATH: Aug 15, 1912
15. I HEREBY CERTIFY, That I attended deceased from (date): June 1, 1912 to Aug 15, 1912
That I last saw him/her alive on (date): Aug 14, 1912
And that death occurred on the date stated above at (time AM/PM): 5PM
THE CAUSE OF DEATH was as follows:
Tuberculosis of bowels
(Duration)
Years:
Months: 2
Days: 15
Signed (M.D.): R.W. Meador
Date: 
Address:
16. 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:
17. PLACE OF BURIAL OR REMOVAL: Alexander Cemetery
DATE OF BURIAL: 8/16/1912
18. UNDERTAKER: J.H. Pile
ADDRESS: Custer, Ky

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Copyright.  All rights reserved.
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