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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Beweleyville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5313
File No.  5833
Registered No:  1
2. FULL NAME:  Rachel A. Carmon
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
6. DATE OF BIRTH:  Feb 19, 1830
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  84 years, 5 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeper
(b.)  General nature of industry business or establishment which employed:  House work
9. BIRTHPLACE:  Breckenridge County, Ky
10. NAME OF FATHER:  Martin Turpin
11. BIRTHPLACE OF FATHER:  Breckenridge County, Ky
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)  William Corman
(Address)  Garfield, Ky
15. Filed  3/2, 1914
REGISTAR:  Julie Compton
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  February 24, 1914 [stamped with DELAY]
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 17, 1914 to Feb 24, 1914
That I last saw him/her alive on (date):  Feb 24, 1914
And that death occurred on the date stated above at (time AM/PM):  11 PM
THE CAUSE OF DEATH was as follows:  La Grippe
 
(Duration)   Years:            Months:    1        Days:  
Contributory:  Senility
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. Sandbach
Date:  Feb 25, 1914
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:  [blank]
DATE OF BURIAL:  [blank]
20. UNDERTAKER:  [blank]
ADDRESS:  
 

ADDITIONAL COMMENTS/NOTES:
 
Breckenridge County Cemetery Book, Volume 1, page 83: 
Carman, Rachel A., 2/19/1830 - 2/24/1914, wife of Wm. is buried in Turpin Cemetery # 1 at Locust Hill.
 

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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