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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Mook
Inc Town:  
City:  
No.  
St.  
Ward  
Registration District No.:  5317
Primary Registration District No:  
File No.  269
Registered No:  3
2.	FULL NAME:  Francis M. Goodman
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  Dec 5, 1910
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 mos  17 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Near Seree
10.	NAME OF FATHER:  V. G. Goodman
11.	BIRTHPLACE OF FATHER:  Hardin Co.
12.	MAIDEN NAME OF MOTHER:  Nettie Tucker
13.	BIRTHPLACE OF MOTHER:  Breckenridge Co.
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Hunter Henninger
(Address)  West View, Ky
15.	Filed  Jan 22, 1911
REGISTAR:  V. G. Goodman
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Jan 22, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Jany 6, 1911 to Jany 22, 1911
That I last saw him/her alive on (date):  Jany 21, 1911
And that death occurred on the date stated above at (time AM/PM):  12:01 a.m.
THE CAUSE OF DEATH was as follows:  Blood poising due to obstruction of the bile ducts of the liver

(Duration)   Years:            Months:            Days:  4
Contributory:  to Gastroen-teritis

(Duration)   Years:            Months:            Days:  16
Signed (M.D.):  J. E. Matthews
Date:  Jany 22, 1911	
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  Fair View
DATE OF BURIAL:  Jan 22, 1911
20.	UNDERTAKER:  Hunter Henninger	
ADDRESS:  West View, Ky
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Copyright.  All rights reserved.
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