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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:  BRECKENRIDGE
Vot. Pol.:  HARDINSBURG, KY
Inc Town:  
City:   
No.  
St.  
Ward:   1
Registration District No.:   13
Primary Registration District No:  530 
File No.  3579
Registered No:  148
2. FULL NAME:  MARVIN LEE DYER JR
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  JULY 3, 1912
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):    YR 7 MO  11 DA     MIN
8. OCCUPATION (a.) Trade, profession or particular kind of work:  AT HOME
(b.)  General nature of industry business or establishment which employed:   
9. BIRTHPLACE:  KENTUCKY
10. NAME OF FATHER:  MARVIN DYER
11. BIRTHPLACE OF FATHER:  KENTUCKY
12. MAIDEN NAME OF MOTHER:  KATIE LEE SLAUGHTER
13. BIRTHPLACE OF MOTHER:  KENTUCKY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MARVIN DYER
(Address)  HARDINSBURG KY
15. Filed  JULY 2  1913
REGISTAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JULY 1,   1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  MAY 20, 1913 TO JULY 1, 1913
That I last saw him/her alive on (date):  HER ALIVE JULY 1,  1913
And that death occurred on the date stated above at (time AM/PM):  5:30 P 
THE CAUSE OF DEATH was as follows:    TENACIOUS VOMITING
 
(Duration)   Years:              Months:     2       Days:  
Contributory:   PREGNANCY
 
(Duration)   Years:            Months:    4        Days:   
Signed (M.D.):  WM L MILES
Date:   JULY 2, 1913
Address:  UNION STAR, KY
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:  JULY 2, 1913
20. UNDERTAKER:  D S RICHARDSON
ADDRESS:   
 

ADDITIONAL COMMENTS/NOTES:


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Copyright.  All rights reserved.
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