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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.:McDaniels, Ky
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No:
File No.  30577
Registered No:
2. FULL NAME:  Charles Alexander Hall
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  February 11, 1859
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  52 yrs, 2 months, 10 days
8. OCCUPATION:  
(a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  Blacksmith
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Thomas Hall
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Glasscock
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant):  Dr. S. J. Hall
(Address):  Constantine, Ky
15. Filed:  Nov 28, 1911
REGISTAR:  M. M. Jarbon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  12-1-1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Sept 8, 1911 to Nov 28, 1911
That I last saw him/her alive on (date):  Nov 28, 1911
And that death occurred on the date stated above at (time AM/PM): 5 am
THE CAUSE OF DEATH was as follows:  Hear failure caused from excitement due to Hematunesis caused by {illegible}

(Duration)
Years:
Months:  2
Days:  28
Contributory:  unknown drugs
(Duration)
Years:
Months:  3
Days:  5
Signed (M.D.): L. J. Halles
Date:  Dec 3, 1911
Address: Constantine
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
DATE OF BURIAL:
20. UNDERTAKER:
ADDRESS:

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Copyright.  All rights reserved.
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