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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.: 11
Inc Town:
City: Webster, Ky
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5311
File No. 432
Registered No:
1. FULL NAME: Mathew M Chappell
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: June  3, 1845
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 66yrs7mos11ds
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: Wm F Chappell
10. BIRTHPLACE OF FATHER: Ky
11. MAIDEN NAME OF MOTHER: Sarah Stiff
12. BIRTHPLACE OF MOTHER: Va
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Levi T Pollock
(Address) Raymond, Ky
14. Filed June 20, 1912
REGISTAR: H. Drane
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Jan 17, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Jan 16, 1912 to Jan 17, 1912
That I last saw him/her alive on (date): Jan 17, 1912
And that death occurred on the date stated above at (time AM/PM): 4PM
THE CAUSE OF DEATH was as follows:
Apoplexy resulting in paralysis
(Duration)
Years:
Months:
Days:
Signed (M.D.): S.P. Parks  M.D.
Date: Jan 18, 1912
Address:
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: Raymond
DATE OF BURIAL: Jan 18, 1912
19. UNDERTAKER: G. T. Marshall & Son
ADDRESS: Irvington

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Copyright.  All rights reserved.
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