************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Hardensburg
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5302
File No.  6355
Registered No:  162
2. FULL NAME:  
PERSONAL AND STATICAL PARTICULARS
3. SEX:  male
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  July 16, 1912
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  8 mo & 27 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  R. A. Gilpin
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Cora Bandy
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  [blank]
(Address)  [blank]
15. Filed  March 13, 1912
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 13, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  March 10 to March 13, 1913
That I last saw him/her alive on (date):  March 12, 1913
And that death occurred on the date stated above at (time AM/PM):  1:15 AM
THE CAUSE OF DEATH was as follows:  Bronco-Pneumonia
 
(Duration)   Years:            Months:            Days:  4 days
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. E. Matthews
Date:  March 13, 1913
Address:  Westview, 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:  Garfield Cemetery
DATE OF BURIAL:  March 13, 1913
20. UNDERTAKER:  Robert Weatherford
ADDRESS:  Harned, KY
 

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