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File contributed for use in USGenWeb Archives by:
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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


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Copyright.  All rights reserved.
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