************************************************************************ 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. Pct: WEBSTER Inc Town: City: No. St. Ward: Registration District No.: 5311 Primary Registration District No: File No. 3224 Registered No: 2. FULL NAME: DYE, ANDREW S. PERSONAL AND STATISTICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: WIDOWER 6. DATE OF BIRTH: MAY 20, 1835 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 76 / 8 / 15 8. OCCUPATION (a.) Trade, profession or particular kind of work: FARMER (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: PULASKI CO, KY 10. NAME OF FATHER: 11. BIRTHPLACE OF FATHER: 12. MAIDEN NAME OF MOTHER: 13. BIRTHPLACE OF MOTHER: 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) ACHILLES J. DYE (Address) CLIFTON MILLS, KY 15. Filed 3/4/ 1912 REGISTAR: HOLLIS DUNN MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: FEB 5, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): JAN 25, 1912 to FEB 4, 1912 That I last saw him/her alive on (date): FEB 4, 1912 And that death occurred on the date stated above at (time AM/PM): 2 AM THE CAUSE OF DEATH was as follows: BRIGHTS DISEASE - KIDNEYS (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: 8 Days: Signed (M.D.): H.R. KURTZ Date: Address: CLIFTON MILLS 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: WALNUT GROVE DATE OF BURIAL: 20. UNDERTAKER: G.T. MARSHALL ADDRESS: ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************