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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.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  2
Registration District No.:  130
Primary Registration District No:  5302
File No.  8811
Registered No:  23
2. FULL NAME:  Critchlow, Sam
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Mar 3 1870
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  41 yr 1 mo 13 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  Farming
9. BIRTHPLACE:  Ky
10. NAME OF FATHER:  Stephen Critchlow
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER: Sarah E. Downs
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. Ben Ed Gray
(Address)  Harned, KY
15. Filed  Apr 27 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Apr. 26, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 25, 1911
That I last saw him/her alive on (date):  Apr. 25, 1911
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  Tumor of brain

(Duration)   Years:            Months:   7       Days:  
Contributory:  Uraemia

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  John E. Kincheloe
Date:  Apr. 26, 1911
Address:  Hardinsburg, KY
18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  2 mo 1 da
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  Glendean, KY
Former or usual residence:  Glendean, KY
19. PLACE OF BURIAL OR REMOVAL:  Scott Cemetery
DATE OF BURIAL:  Apr. 27, 1911
20. UNDERTAKER:  Robert Weatherford
ADDRESS:  Harned, KY

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Copyright.  All rights reserved.
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