************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: BIG SPRING Inc Town: NEAR BIG SPRING City: No. St. Ward: Registration District No.: 5314 Primary Registration District No: 14 File No. 17903 Registered No: 16 2. FULL NAME: CARTER, DELLAH PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: AUG 30, 1912 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 0 / 10 / 2 8. OCCUPATION (a.) Trade, profession or particular kind of work: NONE (b.) General nature of industry business or establishment which employed: AT HOME 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: VENNIE CARTER 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: LATISHIA ST. CLAR [ST. CLAIRE ?] 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) PEYTON SMITH (Address) CUSTER, KY 15. Filed JUL 4, 1913 REGISTAR: J.L. MORRIS MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JUL 2, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): JUN 23, 1913 to JUL 2, 1913 That I last saw him/her alive on (date): JUL 2, 1913 And that death occurred on the date stated above at (time AM/PM): 2 PM THE CAUSE OF DEATH was as follows: TUBERCULAR MENINGITIS (Duration) Years: Months: Days: 9 Contributory: (Duration) Years: Months: Days: Signed (M.D.): R.W. MEADOR Date: JUL 3, 1913 Address: CUSTER, 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: KASEY CEMETERY DATE OF BURIAL: JUL 3, 1913 20. UNDERTAKER: ALF TAYLOR ADDRESS: CUSTER, KY ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************