************************************************************************ 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.: Stephensport Inc Town: “ , Ky City: No. St. Ward: Registration District No.: 5308 Primary Registration District No: File No. 27961 Registered No: 64 2. FULL NAME: Cynthia Dowell PERSONAL AND STATICAL PARTICULARS 3. SEX: Female 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: widowed 6. DATE OF BIRTH: Jan 26, 1833 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 71 yrs 10 mos 6 ds 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Ky 10. NAME OF FATHER: Eli Robbins 11. BIRTHPLACE OF FATHER: Ky 12. MAIDEN NAME OF MOTHER: Betty Hanks 13. BIRTHPLACE OF MOTHER: Ky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Claud Morris (Address) Sample, Ky 15. Filed Nov. 9, 1914 REGISTAR: R. A. Hullman MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Nov. 2, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): Oct. 1, 1912 to Nov. 2, 1914 That I last saw him/her alive on (date): Nov. 1, 1914 And that death occurred on the date stated above at (time AM/PM): 7 a.m. THE CAUSE OF DEATH was as follows: Aortic - insuffisiency (Duration) Years: 2 Months: Days: Contributory: Chronic Nephritis (Duration) Years: 8 Months: Days: Signed (M.D.): Geo. E. Shively, M.D. Date: Nov. 2, 1914 Address: Stephensport 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: Near Sample, Ky DATE OF BURIAL: Nov. 4, 1914 20. UNDERTAKER: C. A. Tinius ADDRESS: Stephensport, Ky 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 ************************************************************************