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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Union Star
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  11
File No.  17468
Registered No:  
2.	FULL NAME:  Oral Coomes
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  Aug – 14 - 1882
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  31 Yrs  11 mos  2 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Meade, Co.
10.	NAME OF FATHER:  B. J. Coomes
11.	BIRTHPLACE OF FATHER:  Meade, Co.
12.	MAIDEN NAME OF MOTHER:  Sarah Abner
13.	BIRTHPLACE OF MOTHER:  Meade, Co.
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  T. J. Hendrick
(Address)  Webster, Ky
15.	Filed  July 16, 1914
REGISTAR:  
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  July – 16 - 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  July 5, 1914 to July 16, 1914
That I last saw him/her alive on (date):  July 16, 1914
And that death occurred on the date stated above at (time AM/PM):  7 a.m.
THE CAUSE OF DEATH was as follows:  Typhoid Fever

(Duration)   Years:            Months:            Days:  
Contributory:  Perforation of Intestine

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  T. J. Hendrick
Date:  July 16, 1914
Address:  Webster, 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:  Raymond, Ky
DATE OF BURIAL:  July 8, 1914
20.	UNDERTAKER:  Wright
ADDRESS:  Brandenburg, Ky


ADDITIONAL COMMENTS/NOTES:




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