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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.:  Balltown, KY  
Inc Town:
City:
No.  5321  
St.
Ward
Registration District No.:
Primary Registration District No:
File No.  5645   [ NOTE:  see Cert. # 11203 – Vol. 29 – duplicate]
Registered No:  2
2. FULL NAME:  Ferry  stillborn 
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:
6. DATE OF BIRTH:  March 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:  KY
10. NAME OF FATHER:  James Ferry
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Bettie Amos  
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  P. E. Dempster, M. D. 
(Address)  Glendean, KY
15. Filed  Mar. 21, 1911   
REGISTAR:  Fred Frank
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 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.):  R. T. and P. E. Dewpster, M. D. 
Date:  March 20, 1911
Address:  Glendean, 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  Bates Cemetery
DATE OF BURIAL:  Mar 14, 1911
20. UNDERTAKER:
ADDRESS:

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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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************************************************