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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
Inc Town:
City:
No.
St.
Ward
Registration District No.:  5318
Primary Registration District No:
File No.  5640
Registered No:  18
2. FULL NAME:  Stella Ray Hall
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  March 23, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 1 ½ 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:  Plummer Hall
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Mamie Canvill
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant):  Arear Hall
(Address)
15. Filed:  March 24, 1911
REGISTAR: M. M. Jarbon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 24, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  March 22, 1911
That I last saw him/her alive on (date):  March 23, 1911
And that death occurred on the date stated above at (time AM/PM):  10 PM 3/24
THE CAUSE OF DEATH was as follows:  some obstruction or deformity of the oesophagus – child was unable to swallow

(Duration)
Years:
Months:
Days: 1 ½ 
Signed (M.D.):  J. B. Lampton
Date:  March 28, 1911
Address:  McDaniels, 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:  Antioch Cemetery
DATE OF BURIAL:  March 25, 1911
20. UNDERTAKER:  Citizens
ADDRESS:  Madrid, Ky

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Copyright.  All rights reserved.
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