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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.:  Hardinsburg, KY
Inc Town:
City:
No.  1
St.
Ward  3
Registration District No.:  130
Primary Registration District No:
File No.  2953
Registered No:  13
2. FULL NAME:   Fowler, Louisa Kennedy
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Aug. 22, 1857
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  53 yrs.  5 mos.  24 ds.  
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeping
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:  Near Garfield ??  KY
10. NAME OF FATHER:  James Kennedy
11. BIRTHPLACE OF FATHER:  Breckinridge Co., KY
12. MAIDEN NAME OF MOTHER:  Polly Ann McCoy
13. BIRTHPLACE OF MOTHER:  Breckinridge Co, KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Fred Basham
(Address)  Hardinsburg, KY
15. Filed  Feb. 17, 1911  
REGISTAR:  W. B. Lennore
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  February 16, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 11, 1911 to Feb. 16, 1911
That I last saw him/her alive on (date):  Feb. 16, 1911
And that death occurred on the date stated above at (time AM/PM):  12 p.m.
THE CAUSE OF DEATH was as follows:
Stricture of bowel, resulting from old adhesions
(Duration)
Years:
Months:
Days:  5 ds. 
Signed (M.D.):  A. M. Kincheloe
Date:  Feb. 16, 1911
Address: Hardinsburg, 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  Freedom Cemetery  ?????
DATE OF BURIAL:  Feb. 17, 1911
20. UNDERTAKER:  J. B. Payne & Co.  
ADDRESS:  Harned, KY

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Copyright.  All rights reserved.
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