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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  12
Inc Town:  Irvington
City:  Irvington
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  14876 [63 handwritten partially over the 14]
Registered No:  5312
2. FULL NAME:  Robert William Hale
PERSONAL AND STATICAL PARTICULARS
3. SEX:  M.
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  M.
6. DATE OF BIRTH:  Nov 14, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  2 years, 7 months, 13 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  [Carpenter crossed out] child
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Irvington, Breckenridge Co., Ky
10. NAME OF FATHER:  William Hale
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Lilla P. Musgrove
13. BIRTHPLACE OF MOTHER:  Indiana
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Will Hale
(Address)  Irvington, Ky
15. Filed  June 30, 1914
REGISTAR:  D. W. Henry
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  June 28, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  June 27, 1914
That I last saw him/her alive on (date):  June 27, 1914
And that death occurred on the date stated above at (time AM/PM):  5 AM
THE CAUSE OF DEATH was as follows:  Inanition
 
(Duration)   Years:     2       Months:    7        Days:  13
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  L. B. Moorman
Date:  June 28, 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:  Blackford
DATE OF BURIAL:  June 29, 1914
20. UNDERTAKER:  G. T. Marshall & Son
ADDRESS:  Irvington, Ky
 

ADDITIONAL COMMENTS/NOTES:
Inanition is a physical condition resulting from lack of food.
 
 

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