************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: STEPHENSPORT Inc Town: City: No. St. Ward: Registration District No.: Primary Registration District No: 5308 File No. 12267 Registered No: 2. FULL NAME: ANDREW CRAWFORD PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: AUG 27, 1840 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 8. OCCUPATION (a.) Trade, profession or particular kind of work: TOBACCOIST (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: SCARBORO, CANADA 10. NAME OF FATHER: JOHN CRAWFORD 11. BIRTHPLACE OF FATHER: AYRSHIRE, SCOTLAND 12. MAIDEN NAME OF MOTHER: MARGUETTE RESIDE 13. BIRTHPLACE OF MOTHER: DALRY AYRSHIRE, SCOTLAND 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) MRS. M.L. ROBERTS (Address) STEPHENSPORT, KY 15. Filed MAY 22, 1913 REGISTAR: RA SHELLMAN MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: MAY 20TH, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date):--TO MAY 20, 1913 That I last saw him alive on (date): MAY 20, 1913 And that death occurred on the date stated above at (time AM/PM): 8AM THE CAUSE OF DEATH was as follows: ORGANIC HEART TROUBLE (Duration) Years: Months: Days: Contributory: AGUE (Duration) Years: Months: Days: Signed (M.D.): GEO. E SHIVELY Date: 5/20/1913 Address: STEPHENSPORT, 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: STEPHENSPORT, KY DATE OF BURIAL: MAY 22, 1913 20. UNDERTAKER: W.J. SCHOPP ADDRESS: STEPHENSPORT, KY ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************