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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Webster
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5311
File No. 6186
Registered No:
1. FULL NAME: Floid Carter
PERSONAL AND STATICAL PARTICULARS
2. SEX: boy 
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: June 1, 1912
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 1yr9mos27ds
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Cliftonmills, Breckinridge Co
9. NAME OF FATHER: Jessie Carter
10. BIRTHPLACE OF FATHER: Breckinridge Co, Ky
11. MAIDEN NAME OF MOTHER: Veola Carter
12. BIRTHPLACE OF MOTHER: Ohio Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Jessie Carter
(Address) Clifton Mills
14. Filed 3/28/1912
REGISTAR: Hollis Drane
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: March 28, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): March 28, 1912 to March 28, 1912
That I last saw him/her alive on (date): March 28, 1912
And that death occurred on the date stated above at (time AM/PM): 5:30 AM
THE CAUSE OF DEATH was as follows:
Acute Indigestion
(Duration)
Years:
Months:
Days: 1
Signed (M.D.): T.J. Hendrick
Date: 3/28/1912
Address: Webster, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Walnut Grove
DATE OF BURIAL: 3/29/1912
19. UNDERTAKER: Jim Carter
ADDRESS:
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