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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.: 5307
Inc Town:
City:  Cloverport, KY
No.  131
St.
Ward  3
Registration District No.:
Primary Registration District No:
File No.  22675
Registered No:  37
2. FULL NAME:  Etherton, Laura Bell Carter
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  Feb. 8, 1862
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  49 yrs. 7 moos 28 ds.
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House work
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:    Kentucky
10. NAME OF FATHER:  Tom Carter
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Stacey Barker or Barber ??
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Lora  May Barker or Doro May Barker/Barber??
(Address)  Owensboro, KY
15. Filed   Sept. 29, 1911
REGISTAR:  J. ????????????????
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Sept. 28, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  July 1st 1911 to Aug. 1st, 1911
That I last saw him/her alive on (date):  Aug 1st, 1911
And that death occurred on the date stated above at (time AM/PM):  4a.m.
THE CAUSE OF DEATH was as follows:
Phthisis Pulmonalis  Contributory Exposure
(Duration)
Years:
Months:  3 mos. 
Days:
Signed (M.D.):  C. R. Lightfoot, M.D.
Date:  Sept. 29, 1911
Address:  Cloverport, 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   Tobinsport, Ind.  
DATE OF BURIAL:  Sept. 29, 1911
20. UNDERTAKER:   M. Hamman & Son    
ADDRESS:  Cloverport, KY 

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Copyright.  All rights reserved.
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