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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.:  HARDINSBURG

Inc Town:  

City:  

No.  

St.  

Ward:  1ST

Registration District No.:  53- - 

Primary Registration District No:  130

File No.  8807

Registered No:  25

2.        FULL NAME:  CARWILE, MARGARET McGUIRE

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  FEMALE

4.        COLOR OR RACE:  WHITE

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

6.        DATE OF BIRTH:  NOV, 25, 1833   [CALCULATED BASED ON REPORTED AGE]

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  78 / 5 / 3

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

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

9.        BIRTHPLACE:  OHIO   [STATE]

10.     NAME OF FATHER:  JOHN McGUIRE

11.     BIRTHPLACE OF FATHER:  OHIO   [STATE]

12.     MAIDEN NAME OF MOTHER:  UNKNOWN

13.     BIRTHPLACE OF MOTHER:  OHIO   [STATE]

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

(Informant)  S.P. LEISURE [?]     [FADED ENTRY]

(Address)  GLEN DEAN

15.     Filed  APR 25, 1911

REGISTAR:  W.B. LENNON

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  APR 28, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  APR 16, 1911 to APR 16, 1911

That I last saw him/her alive on (date):  APR 16, 1911

And that death occurred on the date stated above at (time AM/PM):  2 AM

THE CAUSE OF DEATH was as follows:  NEPHRITIS

 

(Duration)   Years:     5       Months:     3       Days:  4

Contributory:  SINILITY   [sp: CENILITY]

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  W.H. LUCAS

Date:  APR 28, 1911

Address:  McQUADY

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:  

DATE OF BURIAL:  APR 28, 1911

20.     UNDERTAKER:  E.F. LYONS

ADDRESS:  McQUADY

 

TRANSCRIBER’S NOTE:  

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