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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.:  5307
Inc Town:  
City:  Cloverport
No.  
St.  
Ward:  
Registration District No.:  2065
Primary Registration District No:  131
File No.  25007
Registered No:  41
2.	FULL NAME:  Celestine Gabe Greenwell
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  June 10, 1911
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  4 mos  3 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  infant
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Kentucky
10.	NAME OF FATHER:  W. H. Greenwell
11.	BIRTHPLACE OF FATHER:  Indiana
12.	MAIDEN NAME OF MOTHER:  Bertha Wethington
13.	BIRTHPLACE OF MOTHER:  Kentucky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  W. H. Greenwell
(Address)  Cloverport, Ky
15.	Filed  Oct 13, 1911
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  October 13, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  October 10, 1911 to October 13, 1911
That I last saw him/her alive on (date):  October 11, 1911
And that death occurred on the date stated above at (time AM/PM):  1:30 a.m.
THE CAUSE OF DEATH was as follows:  Marasmus

(Duration)   Years:            Months:            Days:  30
Contributory:  From birth not a healthy baby

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  F. L. Lightfoot
Date:  Oct. 13, 1911
Address:  Cloverport, 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:  Breckinridge Co., Ky
DATE OF BURIAL:  Oct 13, 1911
20.	UNDERTAKER:  M. Hamman & Son
ADDRESS:  Cloverport, Ky


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Copyright.  All rights reserved.
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