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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.       PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pct:  

Inc Town:  HARDINSBURG

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  21636

Registered No: 118

FULL NAME:  DUNCAN, GEORGE WASHINGTON

PERSONAL AND STATISTICAL PARTICULARS

2.       SEX:     MALE

3.       COLOR OR RACE:  BLACK

4.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE

5.       DATE OF BIRTH: DEC 2, 1888

6.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  23 / 9 / 20

7.       OCCUPATION (a.) Trade, profession or particular kind of work:  

(b.)  General nature of industry business or establishment which employed:  

8.       BIRTHPLACE:  BRECKINRIDGE CO

9.       NAME OF FATHER:  THOMAS DUNCAN

10.   BIRTHPLACE OF FATHER:  BRECKINRIDGE

11.   MAIDEN NAME OF MOTHER:  MALISSA C-CILL

12.   BIRTHPLACE OF MOTHER:  BRECKINRIDGE

13.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  VIRGIL DUNCAN

(Address)  HARDINSBURG

14.   Filed  SEP 23, 1912

REGISTAR:  W.B. LENNON

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  SEP 22, 1912

16.   I HEREBY CERTIFY, That I attended deceased from (date):  APR 20, 1912 to SEP 16, 1912

That I last saw him/her alive on (date):  SEP 20, 1912

And that death occurred on the date stated above at (time AM/PM):  10 AM

THE CAUSE OF DEATH was as follows:  BRONCHITIS OF SEROFL—SIS  ORIGIN

 

(Duration)   Years:      1      Months:            Days:  

Contributory:  DEEP COUGH

 

(Duration)   Years:      1      Months:            Days:  

Signed (M.D.):  J.C. SUTTON

Date:  SEP 23, 1912

Address:  HARDINSBURG

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:  COLORED CEMETERY

DATE OF BURIAL:  SEP 23, 1912

19.   UNDERTAKER:  B.F. BEARD

ADDRESS:  HARDINSBURG

 


 

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Copyright.  All rights reserved.
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