************************************************************************
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.:  Stephensport, KY
Inc Town:  Stephensport
City:
No.  5308
St.
Ward
Registration District No.:
Primary Registration District No:
File No.  25010
Registered No:
2. FULL NAME:   Foster , Erssila J. Perigo
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  Sept 16, 1830
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  81 yrs 1 mo 13 da.
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House work
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  Wm. Perrigo
11. BIRTHPLACE OF FATHER:  NY
12. MAIDEN NAME OF MOTHER:  Elizabeth Herington
13. BIRTHPLACE OF MOTHER: NY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Geo. E. Shively
(Address)  Stephensport
15. Filed  Oct 30, 1911  
REGISTAR:  R. A. Shellman
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Oct 29, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  June 1911 to Sept 1911
That I last saw him/her alive on (date):  Sept 10, 1911
And that death occurred on the date stated above at (time AM/PM): 8:00 a.m.
THE CAUSE OF DEATH was as follows:
acute dysentery  contributory Senility
(Duration)
Years:
Months:
Days:  5
Signed (M.D.):  Geo. E. Shively
Date: Oct 30, 1911
Address:  Stephensport, 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  Stephensport, KY
DATE OF BURIAL:  Oct. 30, 1911
20. UNDERTAKER:  W. J. Schopp
ADDRESS:  Stephensport, KY

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