************************************************************************ 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. Pol.: Mattingly Inc Town: City: No. 5321 St. Ward Registration District No.: 5321 Primary Registration District No: File No. 11203 [NOTE: see cert. #5645 – Vol. 15 – Duplicate] Registered No: 2. FULL NAME: Ferry, Margaret Maria PERSONAL AND STATICAL PARTICULARS 3. SEX: female 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: 6. DATE OF BIRTH: Mar 14, 1911 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: near Mattingly 10. NAME OF FATHER: James S. B. Ferry 11. BIRTHPLACE OF FATHER: Short Creek (KY?) 12. MAIDEN NAME OF MOTHER: Bettie L. Amos 13. BIRTHPLACE OF MOTHER: Richards mills, KY ?? 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) James S. B. Ferry (Address) R. F. D. NO. 1 Glendean, KY 15. Filed Mar 21, 1911 REGISTAR: E. L. Robertson (Fred Frank) In parentheses under Robertson’s name MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Mar 14, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: stillborn (Duration) Years: Months: Days: Signed (M.D.): P. E. Dewpster, M. D. Date: Mar. 29, 1911 Address: Glendean 18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents) At place of death (yr, mo, da.): In the State (yr, mo, da): 26 yrs. Where was disease contracted, if not at place of death? Former or usual residence: 19. PLACE OF BURIAL OR REMOVAL Cave Springs Church? Cane Springs Church?? DATE OF BURIAL: March 15, 1911 20. UNDERTAKER: Ed Hook 21. ADDRESS: Tar Fork, KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************