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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.:  McDaniels
Inc Town:  
City:  
No.  
St.  
Ward  
Registration District No.:  5318
Primary Registration District No:  
File No.  14279
Registered No:  18
2.	FULL NAME:  Robert A. Glasscock
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  November 17, 1838
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  62 yrs  6 mos  24 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Farming
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Kentucky
10.	NAME OF FATHER:  William Glasscock
11.	BIRTHPLACE OF FATHER:  Kentucky
12.	MAIDEN NAME OF MOTHER:  Fannie Daily
13.	BIRTHPLACE OF MOTHER:  Kentucky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mattie Glasscock
(Address)  McDaniels
15.	Filed  Jun 11, 1911
REGISTAR:  M. M. Jarboe
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  June 10, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  June 5, 1911 to June 10, 1911
That I last saw him/her alive on (date):  June 10, 1911
And that death occurred on the date stated above at (time AM/PM):  7 p.m.
THE CAUSE OF DEATH was as follows:  Internal injuries cause by a fall

(Duration)  Years:       Months:       Days:  6                                       
Contributory:  Paralysis of lower limbs 
(Duration)  Years:  14     Months:       Days:
Signed (M.D.):  J. B. Lampton, M.D.
Date:  June 11, 1911
Address:  McDaniels
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  Glasscock Cemetery
DATE OF BURIAL:  June 11, 1911
20.	UNDERTAKER:  Rhodes, Storms & Co.
ADDRESS:  McDaniels

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Copyright.  All rights reserved.
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