************************************************************************ 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.: HARDINSBURG Inc Town: City: No. St. Ward: Registration District No.: 130 Primary Registration District No: 5302 File No. 3285 Registered No: 2. FULL NAME: DALTION, MARTHA JANE PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: 6. DATE OF BIRTH: FEB 16, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 0 / 11 / 27 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: HARDINSBURG 10. NAME OF FATHER: JESS DALTION 11. BIRTHPLACE OF FATHER: HARDINSBURG 12. MAIDEN NAME OF MOTHER: MARTHA JANE DALTION 13. BIRTHPLACE OF MOTHER: HARDINSBURG 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) JESS DALTION (Address) GARFIELD 15. Filed FEB 15, 1915 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: FEB 14, 1915 17. I HEREBY CERTIFY, That I attended deceased from (date): FEB 2, 1915 to FEB 14, 1915 That I last saw him/her alive on (date): FEB 13, 1915 And that death occurred on the date stated above at (time AM/PM): 3 AM THE CAUSE OF DEATH was as follows: LOBAR PNEUMONIA (Duration) Years: Months: Days: 12 Contributory: (Duration) Years: Months: Days: Signed (M.D.): E.C. HARNED Date: GARFIELD Address: 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: BASHAM CEM DATE OF BURIAL: FEB 15, 1915 20. UNDERTAKER: J.B. RICHARDSON ADDRESS: GARFIELD 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 ************************************************************************