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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Stephensport
Inc Town:  Stephensport
City:
No.
St.
Ward
Registration District No.:  5308
Primary Registration District No:
File No.  17189
Registered No:
2. FULL NAME:  William S. Hall
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Yes
6. DATE OF BIRTH:  1830
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  81 yrs
8. OCCUPATION:
(a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:  Hancock Co.
10. NAME OF FATHER:
11. BIRTHPLACE OF FATHER:
12. MAIDEN NAME OF MOTHER:
13. BIRTHPLACE OF MOTHER:
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant):  Richard McAfee
(Address):  Stephensport, Ky
15. Filed:  July 11, 1911
REGISTAR:  R. A. Shellman
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  7-10-1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  4/3, 1911 to 4/9, 1911
That I last saw him/her alive on (date):  4/8, 1911
And that death occurred on the date stated above at (time AM/PM):  6:30 pm
THE CAUSE OF DEATH was as follows:  General debility incident to old age

(Duration)
Years:  5 yrs
Months:
Days:
Contributory: Varicose ulcer & cystitis
(Duration)
Years:  5 yrs
Months:
Days:
Signed (M.D.):  Geo. E. Shively
Date:  7/11, 1911
Address:  Stephensport
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:  Hardingrove, IN
DATE OF BURIAL:  July 11, 1911
20. UNDERTAKER:  W. J. Schopp
ADDRESS:  Stephensport, Ky

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Copyright.  All rights reserved.
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