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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.:
Inc Town:  Irvington, Ky
City:
No.  
St.
Ward
Registration District No.:  5312
Primary Registration District No:
File No.  22684
Registered No:  10
2.	FULL NAME:  Louis  Bandy Gillingwaters
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:
6.	DATE OF BIRTH:  March 25th, 1911
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  5 mos  20 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
9.	BIRTHPLACE:  Breckinridge Co.
10.	NAME OF FATHER:  Owen Gillingwaters
11.	BIRTHPLACE OF FATHER:  Breckinridge Co., Ky
12.	MAIDEN NAME OF MOTHER:  Urtemissa  Bandy
13.	BIRTHPLACE OF MOTHER:  Breckinridge Co., Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
15.	Filed  Sept 14, 1911
REGISTAR:  Jabus Creighton
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  September 13th, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Sept 13th, 1911 to September 13, 1911
That I last saw him/her alive on (date):  September 13, 1911
And that death occurred on the date stated above at (time AM/PM):  11 p.m.
THE CAUSE OF DEATH was as follows:  Meningeal Hemorrhage

(Duration)  Years:       Months:       Days:  1
Contributory
(Duration)  Years:       Months:       Days:
Signed (M.D.):  P. W. Foote  M.D.
Date:  Sept 13, 1911
Address:  Irvington, 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
DATE OF BURIAL:
20.	UNDERTAKER:
ADDRESS:
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Copyright.  All rights reserved.
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************************************************