************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: STEPHENSPORT Inc Town: City: No. St. Ward: Registration District No.: 5308 Primary Registration District No: File No. 25208 Registered No: 60 2. FULL NAME: FENTRESS, RAYMON PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: APR 2, 1890 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 14 / 6 / 15 8. OCCUPATION (a.) Trade, profession or particular kind of work: AT HOME (b.) General nature of industry business or establishment which employed: SCHOOL BOY 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: WILLIAM V. FENTRESS 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: ALICE ESKRIDGE 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) WARREN G. ESKRIDGE (Address) OWENSBORO 15. Filed OCT 20, 1914 REGISTAR: R.A. SHELLMAN MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: OCT 17, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): SEP 24, 1914 to OCT 17, 1914 That I last saw him/her alive on (date): OCT 17, 1914 And that death occurred on the date stated above at (time AM/PM): 7 PM THE CAUSE OF DEATH was as follows: PURULENT PLEURISY (Duration) Years: Months: 2 Days: Contributory: PNEUMONIA (Duration) Years: Months: Days: Signed (M.D.): C.R. LIGHTFOOT Date: OCT 18, 1914 Address: CLOVERPORT 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: SAMPLE, KY DATE OF BURIAL: OCT 18, 1914 20. UNDERTAKER: C.A. TINIUS ADDRESS: STEPHENSPORT ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************