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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Rockvale
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5320
Primary Registration District No:  
File No.  23781
Registered No:  
2. FULL NAME:  Coppage, Liddie
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  May 7, 1878
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  34 yr 1 mo 17 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., KY
10. NAME OF FATHER:  John Rhodes
11. BIRTHPLACE OF FATHER:  Tennessee
12. MAIDEN NAME OF MOTHER:  Susan Matthews
13. BIRTHPLACE OF MOTHER:  Breckinridge Co., KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R. L. Burnett
(Address)  Vanzant, KY
15. Filed  June 20, 1912
REGISTRAR:  J. D. McDonough
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  June 20, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 1, 1912
That I last saw him/her alive on (date):  May 1, 1912
And that death occurred on the date stated above at (time AM/PM):  12:30 PM
THE CAUSE OF DEATH was as follows:  Hereditary tuberculosis

(Duration)   Years:    1        Months:   1         Days:  13
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  W. C. Hedden
Date:  June 20, 1912
Address:  Fordsville, 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:  
DATE OF BURIAL:  
20. UNDERTAKER:  A. P. Miles with H. Wilson & Co.
ADDRESS:  Glen Dean, KY


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