************************************************************************ 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: City: No. St. Ward Registration District No.: 5308 Primary Registration District No: File No. 9231 Registered No: 19 2. FULL NAME: Mary A Furrow PERSONAL AND STATICAL PARTICULARS 3. SEX: Female 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Single 6. DATE OF BIRTH: Feb 18, 1898 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 15 yrs 8 mos 28 da 8. OCCUPATION (a.) Trade, profession or particular kind of work: At Home (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: Murion Furrow 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Mary A Bueham 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Calvin Sletevee (Address) Sample KY 15. Filed April 9, 1912 REGISTAR: R A Shellman MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: April 8, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): (unreadable) That I last saw him/her alive on (date): (unreadable) And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: Pulminary Tuberculosis (Duration) Years: Months: Days: Signed (M.D.): J E Kincheloe Date: April 8, 1912 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 Sample Cemetery DATE OF BURIAL: April 8, 1912 20. UNDERTAKER: B F Beard & Co ADDRESS: Hardinsburg KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************