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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.:  
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5304
File No.  14259
Registered No: 32 
2. FULL NAME:  DeJARNETTE, ZEULAH
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  DEC 13, 1896
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  14 / 5 / 10
8. OCCUPATION (a.) Trade, profession or particular kind of work: 
(b.)  General nature of industry business or establishment which employed:  AT HOME
9. BIRTHPLACE:  KENTUCKY
10. NAME OF FATHER:  KIT DeJARNETTE
11. BIRTHPLACE OF FATHER:  KENTUCKY
12. MAIDEN NAME OF MOTHER:  MOLLIE WITHERS
13. BIRTHPLACE OF MOTHER:  KENTUCKY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  BER--- WITHERS
(Address)  HARDINSBURG
15. Filed  JUN 15, 1911
REGISTAR:  W.B. LENNON
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: JUN 10, 1911 
17. I HEREBY CERTIFY, That I attended deceased from (date):  JUN 4, 1911 to JUN 10, 1911
That I last saw him/her alive on (date):  JUN 10, 1911
And that death occurred on the date stated above at (time AM/PM):  7:20 AM
THE CAUSE OF DEATH was as follows:  MEASLES

(Duration)   Years:            Months:            Days:  11
Contributory:  ANGINA PECTORIS

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  JNO E. KINCHELOR
Date:  JUN 10, 1911
Address:  HARDINSBURG
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:  DeJARNETTE CEMETERY
DATE OF BURIAL:  JUN 11, 1911
20. UNDERTAKER:  
ADDRESS:  HARDINSBURG

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Copyright.  All rights reserved.
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