************************************************************************ 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.: Bewley Ville Inc Town: City: No. 5313 St. Ward Registration District No.: Primary Registration District No: File No. 20135 Registered No: 9 1. FULL NAME: May Dowell PERSONAL AND STATICAL PARTICULARS 2. SEX: female 3. COLOR OR RACE: white 4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married 5. DATE OF BIRTH: Oct 15, 1883 6. AGE (yr. mo. da) (If less than 1 day, hours or min?): 27yrs10mos9ds 7. OCCUPATION (a.) Trade, profession or particular kind of work: House Keeper (b.) General nature of industry business or establishment which employed: Gen House work 8. BIRTHPLACE: Garfield, Ky 9. NAME OF FATHER: Adam Wood 10. BIRTHPLACE OF FATHER: Garfield, Ky Breck. Co 11. MAIDEN NAME OF MOTHER: Susan Taylor 12. BIRTHPLACE OF MOTHER: Garfield, Ky Breck Co 13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant)Leone Woods (Address) Big Springs 14. Filed Aug 25, 1911 REGISTAR: John Compton MEDICAL CERTIFICATE OF DEATH 15. DATE OF DEATH: Aug 24, 1911 16. I HEREBY CERTIFY, That I attended deceased from (date): Feb 26, 1911 to Aug 24, 1911 That I last saw him/her alive on (date): July 21, 1911 And that death occurred on the date stated above at (time AM/PM): 10 am THE CAUSE OF DEATH was as follows: Pulmonary Tuberculosis (Duration) Years: Months: 8 Days: Signed (M.D.): J.A. Sandbach Date: Aug 24, 1911 Address: Garfield, Ky 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 DATE OF BURIAL: 19. UNDERTAKER: ADDRESS: ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************