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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. Pol.:  GLEN DEAN, KY
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:   
Primary Registration District No:  5319
File No.  593
Registered No:   
2. FULL NAME:  ANNIE OLLER EARLY
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  APRIL 13 1893
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  19 YR. 8 MO. 18 DA.
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:   
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  BEN OLLER
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  ELLA MITCHEL
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  WALTER EARLY
(Address)  GLEN DEAN KY
15. Filed  JAN 2, 1913
REGISTAR:  MRS. M.O. ROBERTSON
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JAN 1ST 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  JAN 20, 1912 TO JAN 1, 1913     
That I last saw him/her alive on (date):  ALIVE DEC 28, 1912
And that death occurred on the date stated above at (time AM/PM):  10 M
THE CAUSE OF DEATH was as follows:  TUBUCULOSIS OF LUNGS
 
(Duration)   Years:  1          Months:            Days:   
Contributory:  
 
(Duration)   Years:            Months:            Days:   
Signed (M.D.):  PE DEMPSTER
Date:   JAN 2 1913
Address:  GLEN DEAN  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:   GLEN DEAN CEMETARY
DATE OF BURIAL:  JAN 2 1913
20. UNDERTAKER:  H WILSON & CO
ADDRESS:  GLEN DEAN KY
 

ADDITIONAL COMMENTS/NOTES:

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Copyright.  All rights reserved.
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