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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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PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pct:  #9

Inc Town:  NEAR  CONSTANTINE

City:  

No.  

St.  

Ward:  

Registration District No.:  5309

Primary Registration District No:  

9232File No.  

Registered No: 6

1.       FULL NAME:   FRYMIRE, ELIZABETH JANE

PERSONAL AND STATISTICAL PARTICULARS

2.       SEX:     FEMALE         

3.       COLOR OR RACE:  WHITE

4.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED

5.       DATE OF BIRTH:       OCT 1, 1834

6.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  77 / 6 / 9

7.       OCCUPATION (a.) Trade, profession or particular kind of work:  RETIRED HOUSEWIFE

(b.)  General nature of industry business or establishment which employed:  DUTY OF HOUSEWIFE

8.       BIRTHPLACE:  BRECKINRIDGE CO, KY NEAR NOW FRYMIRE, KY

9.       NAME OF FATHER:  LEONARD MURRY [?]

10.   BIRTHPLACE OF FATHER:  UNKNOWN UNITED STATES

11.   MAIDEN NAME OF MOTHER:  WHEATLY

12.   BIRTHPLACE OF MOTHER:  UNKNOWN

13.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  J.B. BRUNER

(Address)  FRYMIRE, KY

14.   Filed  4/11/1912

REGISTAR:  LEE STEWART

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  APR 10, 1912

16.   I HEREBY CERTIFY, That I attended deceased from (date):  NOV 1, 1911 to NOV 3, 1911

That I last saw him/her alive on (date):  MAR 31, 1912

And that death occurred on the date stated above at (time AM/PM):  9 PM

THE CAUSE OF DEATH was as follows:  - - - - - - - - -  FOLLOWED BY PARTIAL PARALYSIS - - - - - - -  AND EXHAUSTION 

 

(Duration)   Years:            Months:       5     Days:   13  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  J.B. FRYMIRE

Date:  APR 11, 1912

Address:  FRYMIRE, KY

17.   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:  

18.   PLACE OF BURIAL OR REMOVAL:  BRUNER GRAVE YARD

DATE OF BURIAL:  APR 11, 1912

19.   UNDERTAKER:  J.J. SCHOPP

ADDRESS:  STEPHENSPORT

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Copyright.  All rights reserved.
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