************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************


1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg, KY
Inc Town:  5303
City:  
No.  
St.  
Ward: 3  
Registration District No.:  130
Primary Registration District No:  5303
File No.  14256
Registered No: 30 
2. FULL NAME:  Cooper, James Ezra
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  May 9, 1910
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 yr, 0 mo, 17 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  None
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Lewis Edward Cooper
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Addie Harris
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  John Seaton
(Address)  Hardinsburg, KY
15. Filed  June 6, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  June 6, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 1, 1911
That I last saw him/her alive on (date):  Never saw the child dead or alive
And that death occurred on the date stated above at (time AM/PM):  6 PM
THE CAUSE OF DEATH was as follows:  Nephritis

(Duration)   Years:            Months:    2       Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. M. Kincheloe
Date:  June 6, 1911
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:  Mike Miller Cemetery
DATE OF BURIAL:  June 11, 1911
20. UNDERTAKER:  B. F. Beard
ADDRESS:  Hardinsburg

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************