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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.: Stephensport
Inc Town:
City:
No. 5308
St.
Ward
Registration District No.:
Primary Registration District No:
File No. 27664
Registered No:
1. FULL NAME: L.D. Dowell  (written in date of birth- Lorenzo Dave Dowell)
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: May 27, 1837
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?):
7. OCCUPATION (a.) Trade, profession or particular kind of work: farming
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co, Ky
9. NAME OF FATHER: Drink Dowell
10. BIRTHPLACE OF FATHER: Breckinridge Co, Ky
11. MAIDEN NAME OF MOTHER: Plina Snyder
12. BIRTHPLACE OF MOTHER: Breckinridge Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Rev IC Argabright
(Address) Lodiburg, Ky
14. Filed 11-10-1911
REGISTAR: R.A. Shellman
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Nov 9, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Nov 3, 1911 to Nov 9, 1911
That I last saw him/her alive on (date): Nov 8, 1911
And that death occurred on the date stated above at (time AM/PM): 3PM (number is very hard to read)
THE CAUSE OF DEATH was as follows:
Gangrene
(Duration)
Years:
Months:
Days: 6
Contributory: Old Age
Signed (M.D.): Geo. E. Shively
Date: Nov 9, 1911
Address: Stephensport
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Union Star, Ky
DATE OF BURIAL: Nov 10th, 1911
19. UNDERTAKER: W.J. Schopp
ADDRESS: Stephensport, Ky

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Copyright.  All rights reserved.
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