************************************************************************ 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.: 3313 Primary Registration District No: File No. 6187 Registered No: 2 2. FULL NAME: Henry B Dowell PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: March 30, 1875 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 36 years, 11 months, 25 days 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farmer (b.) General nature of industry business or establishment which employed: Farm Work 9. BIRTHPLACE: Garfield, Kentucky, Breckinridge Co 10. NAME OF FATHER: William Dowell 11. BIRTHPLACE OF FATHER: Garfield, Kentucky 12. MAIDEN NAME OF MOTHER: Alsie Wood 13. BIRTHPLACE OF MOTHER: Garfield, Kentucky, Breck Co. 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) C E Dowell (Address) Garfield, Kentucky 15. Filed March 28, 1912 REGISTAR: John Compton MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: March 25, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): June 23, 1911 to March 25, 1912 That I last saw him/her alive on (date): him, 16th March 1912 And that death occurred on the date stated above at (time AM/PM): 1:00 PM THE CAUSE OF DEATH was as follows: Pulmonary Tuberculosis (Duration) Years: Months: 10 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J A Sandbach MD Date: March 25, 1912 Address: Garfield, Kentucky 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: Blank DATE OF BURIAL: Blank 20. UNDERTAKER: Blank ADDRESS: Blank ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************