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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.:  Stephensport
Inc Town: yes
City: Stephensport
No.    5308
St.
Ward
Registration District No.:
Primary Registration District No:
File No.  8815
Registered No:  4
2. FULL NAME:  FOX   Elizabeth J. Watson
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married
6. DATE OF BIRTH:  Aug 2, 1848
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  62 yrs 7 mos 26 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:  Thomas Watson
11. BIRTHPLACE OF FATHER:  Tenn
12. MAIDEN NAME OF MOTHER:  Malindiar  Slader  (??)
13. BIRTHPLACE OF MOTHER:  Ind
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Husband
(Address)  Stephensport, KY
15. Filed  5/5, 1911
REGISTAR:  R. A. Shellman
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  April 27, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  April 5, 1911 to April 27, 1911
That I last saw him/her alive on (date):  April 27, 1911
And that death occurred on the date stated above at (time AM/PM):  8:20 a.m.
THE CAUSE OF DEATH was as follows: 
 Catarrheal condition of alimentary tract 
Contributory age
(Duration
Years:  5
Months: -
Days: -
Signed (M.D.):  George E. Shively
Date:  May 5, 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  (BLANK)
DATE OF BURIAL:  5-28-1911
20. UNDERTAKER:   W. J. Schopp
ADDRESS:  Stephensport, KY

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Copyright.  All rights reserved.
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