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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  GLEN DEAN
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5319
Primary Registration District No:  19
File No.  23839
Registered No:  
2.	FULL NAME:  CRITCHLOW, AMELIA RET CARMAN  [MAY BE PET]
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  FEB 25, 1864
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  51 / 7 / 24
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  HOUSEWIFE
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  LONARD [LEONARD] CARMAN
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  LYDDIE KIMBLE
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  - - - - CRITCHLOW
(Address)  AXTEL
15.	Filed  OCT 18, 1915
REGISTAR:  MRS. MOLLY DEMPSTER
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 18, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  OCT 10, 1915 to OCT 18, 1915
That I last saw him/her alive on (date):  OCT 18, 1915
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  INTERSTITUAL TUBERCULOSIS
(Duration)   Years:   abt 20         Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. LAMPTON
Date:  OCT 19, 1915
Address:  McDANIELS
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:  CRITCHLOW CEMETERY
DATE OF BURIAL:  OCT 19, 1915
20.	UNDERTAKER: RHODES STORMS 
ADDRESS:  McDANIELS


ADDITIONAL COMMENTS/NOTES:




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