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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.:  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

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Copyright.  All rights reserved.
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