************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BIG SPRING
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5314
Primary Registration District No:14
File No.  17472
Registered No: 20 
2.	FULL NAME:  GILPIN, MEADOR
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  INFANT
6.	DATE OF BIRTH:  SEP 3, 1911
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  2 / 10 / 9
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER:  LEM D. GILPIN
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE
12.	MAIDEN NAME OF MOTHER:  LENA CLAYCOMB
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  LOUIS GILPIN
(Address)  
15.	Filed  JUL 20, 1914
REGISTAR:  J.L. LIGHTFOOT
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JUL 11, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  JUN 30, 1914 to JUL 11, 1914
That I last saw him/her alive on (date):  JUL 11, 1914
And that death occurred on the date stated above at (time AM/PM):  10 PM
THE CAUSE OF DEATH was as follows:  SPINAL MENINGITIS
(Duration)   Years:            Months:            Days:    
Contributory:  CURVATURE OF SPINE  [CONGENITAL]

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.W. MEADOR
Date:  JUL 12, 1914
Address:  CUSTER
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:  DOWELL BURYING GROUND
DATE OF BURIAL:  JUL 12, 1914
20.	UNDERTAKER:  TAYLOR & GRAY
ADDRESS:  CUSTER


ADDITIONAL COMMENTS/NOTES:




************************************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************