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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  McDaniels
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5318
Primary Registration District No:  
File No.  3595
Registered No:  
2. FULL NAME:  Wilber Glasscock
PERSONAL AND STATICAL PARTICULARS
3. SEX:  male
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  [blank]
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  14 years, 8 months, 18 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Ky
10. NAME OF FATHER:  J.R. Glasscock
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Vita B. Butler
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  T. B. Butler
(Address)  West View, KY
15. Filed  Feb 6, 1913
REGISTAR:  M. M. Jarboe
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Feb 5, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  July 16, 1912 to Feb 5, 1913
That I last saw him/her alive on (date):  Feb 2, 1913
And that death occurred on the date stated above at (time AM/PM):  9:30 PM
THE CAUSE OF DEATH was as follows:  Pulmonary Tuberculoses
 
(Duration)   Years:      1      Months:            Days:  
Contributory:  Lobal Pneumonia
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. B. Matthews, M.D.
Date:  Feb 6, 1913
Address:  West View, 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:  [blank]
DATE OF BURIAL:  [blank]
20. UNDERTAKER:  [blank]
ADDRESS:  [blank]
 

ADDITIONAL COMMENTS/NOTES:
No sign of Wilber or his mother Vita in the Breckenridge County Cemetery books, but, father John R. Glasscock (consort of Vitie B.) is buried in Mt. Zion Methodist Church Cemetery located between Kingswood and West View, about 3 miles south of Harned.
 
 

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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