************************************************************************ 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 Inc Town: City: No. St. Ward: Registration District No.: 130 Primary Registration District No: 5302 File No. 424 Registered No: 73 2. FULL NAME: S Moses Crume PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: October 28, 1853 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 58 years, 4 mos, 9 days 8. OCCUPATION (a.) Trade, profession or particular kind of work: Merchant (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KY 10. NAME OF FATHER: John Crume 11. BIRTHPLACE OF FATHER: KY 12. MAIDEN NAME OF MOTHER: Nancy Mattingham ?? 13. BIRTHPLACE OF MOTHER: KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) V G Goodman (Address) Harned, KY 15. Filed Jan 7, 1912 REGISTAR: W B Lennon MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: January 7, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): May 20, 1911 That I last saw him/her alive on (date): Januy 7, 1912 And that death occurred on the date stated above at (time AM/PM): 5:19 am THE CAUSE OF DEATH: exhaustion from arteriosclerosis, neuritis and chronic bronchitis (Duration) Years: Months: 9 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J E Matthews Date: January 7, 1912 Address: Westview, 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: Scott Cemetary DATE OF BURIAL: January 8, 1912 20. UNDERTAKER: Robert Weatherford ADDRESS: Harned, KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************