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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.: Hudson

Inc Town:

City:

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 19030

Registered No: 13

2.       FULL NAME: Roy Galoway

PERSONAL AND STATICAL PARTICULARS

3.       SEX: M

4.       COLOR OR RACE: W

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Single

6.       DATE OF BIRTH: December 17, 1901

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 11 yrs 7 mos 28 da

8.       OCCUPATION (a.) Trade, profession or particular kind of work: Lived at home

(b.)  General nature of industry business or establishment which employed: on farm

9.       BIRTHPLACE: KY

10.   NAME OF FATHER: Joss E Galoway

11.   BIRTHPLACE OF FATHER: KY

12.   MAIDEN NAME OF MOTHER: Ramsey

13.   BIRTHPLACE OF MOTHER: KY

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

(Informant) Gid Armes

(Address) Eveleigh KY

15.   Filed 8/29, 1912

REGISTAR: J H Comer

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: August 28, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Aug 27, 1912 to Aug 28, 1912

That I last saw him/her alive on (date): Aug 27, 1912

And that death occurred on the date stated above at (time AM/PM): 5 AM

THE CAUSE OF DEATH was as follows: Superative Apendicitis

 

(Duration)

Years:

Months: 2

Days:

Contributory: Hepatic Abcess

(Duration) 

Years:

Months: 

Days: 15

Signed (M.D.): Marcus Phelps

Date: Aug 28, 1912

Address: Lietchfield

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 Mt Gillead

DATE OF BURIAL: 29, 1912

20.   UNDERTAKER: J H Holmes

ADDRESS: Eveleigh KY




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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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