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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hudson, Ky
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5316
File No. 438
Registered No: 1
1. FULL NAME: Robert Cavit
PERSONAL AND STATICAL PARTICULARS
2. SEX: male 
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: 1/24/1874
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 38yr
7. OCCUPATION (a.) Trade, profession or particular kind of work: farmer
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: 
10. BIRTHPLACE OF FATHER:
11. MAIDEN NAME OF MOTHER: Ellen Kinnison
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) David Pullen
(Address) Hudson, Ky
14. Filed 1/26/1912
REGISTAR: JH Comer
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: 1/24/1912
16. I HEREBY CERTIFY, That I attended deceased from (date): 11-11, 1911 to 12-20, 1911
That I last saw him/her alive on (date): Dec 30, 1911
And that death occurred on the date stated above at (time AM/PM):
THE CAUSE OF DEATH was as follows:
Tuberculosis pulmonallis
(Duration)
Years:
Months: 2
Days:
Signed (M.D.): S.J. Hall
Date: 1/25/1912
Address: Constantine
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: Coyles Grave yd.
DATE OF BURIAL: 1/25/1912
19. UNDERTAKER: Leitchfield Mer Co
ADDRESS: Leitchfield, Ky

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Copyright.  All rights reserved.
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