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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  12
Inc Town:  Irvington, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  20320
Registered No:  5312
2. FULL NAME:  Sophia Greenwell
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  black
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widow
6. DATE OF BIRTH:  1854  59 years old
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  59 years
8. OCCUPATION (a.) Trade, profession or particular kind of work:  H. Wrk
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Bewelyville
10. NAME OF FATHER:  John Davenport
11. BIRTHPLACE OF FATHER:  Bewelyville, Ky
12. MAIDEN NAME OF MOTHER:  Don't Know
13. BIRTHPLACE OF MOTHER:  Bewelyville
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  
(Address)  
15. Filed  Aug 18, 1914
REGISTAR:  Mrs. Sue C. Jolly
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  August 18, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  July  to August 17, 1914
That I last saw him/her alive on (date):  August 12, 1914
And that death occurred on the date stated above at (time AM/PM):  6 AM
THE CAUSE OF DEATH was as follows: Angina Pectoris
 
(Duration)   Years:   1         Months:            Days:  
Contributory:  Use of  Tobacco Excess
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  L. B. Moorman
Date:  8 / 18. 1914
Address:  Irvington, 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:  Irvington
DATE OF BURIAL:  8/19, 1914
20. UNDERTAKER:  G. T. Marshall & Son
ADDRESS:  Irvington
 

ADDITIONAL COMMENTS/NOTES:
 
 
 

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