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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  
City:  IRVINGTON
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  
Registered No:  14054
2.	FULL NAME:  HARPER, MELINDA COLLINS
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  DECEMBER 14, 1850
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  65 / 6 / 10
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  JAMES COLLINS
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  LeGRAND
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JOHN HARPER
(Address)  IRVINGTON
15.	Filed  JUN 4, 1915
REGISTAR:  MRS. SUE JOLLY
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JUN 4, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAR 14, 1915 to JUN 4, 1915
That I last saw him/her alive on (date):  JUN 3, 1915
And that death occurred on the date stated above at (time AM/PM):  4 PM
THE CAUSE OF DEATH was as follows:  NEPHRITIS
(Duration)   Years:            Months:            Days:    
Contributory:  VALVULAR HEART TROUBLE
(Duration)   Years:      2      Months:            Days:  
Signed (M.D.):  S.P. PARKS
Date:  JUN 4, 1915
Address:  IRVINGTON
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:  WEBSTER, KY
DATE OF BURIAL:  JUN 5, 1915
20.	UNDERTAKER:  G.T. MARSHALL & SONS
ADDRESS:  IRVINGTON


ADDITIONAL COMMENTS/NOTES:  THE MONTH OF BIRTH IS SMEARED BUT CLEARLY ENDS AS "...MBER"
HOWEVER, WHEN EXTRAPOLATING THE BIRTH DATE FROM THE GIVEN DEATH DATE THE BIRTHDATE IS CLEARLY
MISCALCULATED. EITHER THE BIRTHDATE OR THE LISTED AGE IS INCORRECT.



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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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