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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.:  Hardinsburg
Inc Town:
City:
No.
St.
Ward:  1
Registration District No.:
Primary Registration District No:
File No.  2952
Registered No:  12
2. FULL NAME:  Mildred Norine Guess
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED::  Single
6. DATE OF BIRTH:  February 5, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  10 days
8. OCCUPATION:
(a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:  Ky
10. NAME OF FATHER:  Johnse Guess
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Elizabith Shellie Hennings
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant):  Johnse (his mark X) Guess
(Address):  Kirk, Ky
15. Filed:  Feb 16, 1911
REGISTAR:  W.B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  February 15, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):
That I last saw him/her alive on (date):  February 5, 1911
And that death occurred on the date stated above at (time AM/PM):
THE CAUSE OF DEATH was as follows:  Unknown

(Duration)
Years:
Months:
Days:
Signed (M.D.):  J. Ewauhews
Date:  February 16, 1911
Address:  Westview, 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:  Durham Cemetery
DATE OF BURIAL:  February 16, 1911
20. UNDERTAKER:  None hand made coffin
ADDRESS:

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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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