************************************************************************ 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.: BEWLEYVILLE Inc Town: City: No. St. Ward: Registration District No.: Primary Registration District No: 5313 File No. 14269 Registered No: 2 2. FULL NAME: DOWELL, CLINTON PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: APR 11, 1856 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 51 / 1 / 25 8. OCCUPATION (a.) Trade, profession or particular kind of work: FARMER (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: BRECKINRIDGE 10. NAME OF FATHER: JOHN W. DOWELL 11. BIRTHPLACE OF FATHER: BRECKINRIDGE 12. MAIDEN NAME OF MOTHER: LETA MCELVY 13. BIRTHPLACE OF MOTHER: BRECKINRIDGE 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) AMOS F. SIPES (Address) IRVINGTON 15. Filed JUN 7, 1911 REGISTAR: JOHN COMPTON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JUN 6, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): JAN 9, 1911 to JUN 6, 1911 That I last saw him/her alive on (date): JUN 6, 1911 And that death occurred on the date stated above at time AM/PM): 8:30 PM THE CAUSE OF DEATH was as follows: TUBERCULOSIS (Duration) Years: Months: 5 Days: Contributory: LAGRIPPE (Duration) Years: Months: Days: Signed (M.D.): A.A. BAXTER Date: 6/7/1911 Address: GUSTON, KY [MEADE COUNTY] 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: GARFIELD DATE OF BURIAL: JUN 7, 1911 20. UNDERTAKER: G.T. MARSHALL & SONS ADDRESS: IRVINGTON ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************