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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.: 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:

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Copyright.  All rights reserved.
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