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1.	PLACE OF DEATH
County: BRECKINRIDGE 
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward:  3
Registration District No.:  130
Primary Registration District No: 5303 
File No. 26152 
Registered No:  
2.	FULL NAME: JAMIEL ORVAL COLLARD  
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE: WHITE 
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 
6.	DATE OF BIRTH: SEPTEMBER 11, 1913
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 1MOS 3DS 
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  COLUMBUS COLLARD
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  EFFIE MAY BLAIR
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  THOMAS CARWILE
(Address)  HARDINSBURG, KY
15.	Filed  OCT 15, 1913
REGISTAR:  WB LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: 10-14-1913 
17.	I HEREBY CERTIFY, That I attended deceased from (date): SEPT 11, 1913 TO OCT 14, 1913 
That I last saw him/her alive on (date): OCT  7, 1913 
And that death occurred on the date stated above at (time AM/PM): 9 ½ AM 
THE CAUSE OF DEATH was as follows:  
INANITION
(Duration)   Years:            Months: 1          Days:  3
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.E. KINCHELOE
Date: 10-14-1913 
Address: HARDINSBURG, 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: HENRY MILLER CEMETERY 
DATE OF BURIAL:  OCT 15, 1913
20.	UNDERTAKER:  B.F. BEARD & CO
ADDRESS:  HARDINSBURG, KY


ADDITIONAL COMMENTS/NOTES:
According to Breck Co Cemeteries Book Vol 1, his name was James Abvil Collard.  Both parents are buried at New Ivy Hill Cemetery.



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