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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.: BEWLEYVILLE 
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5317
Primary Registration District No:  
File No. 586 
Registered No: 1 
2.	FULL NAME: DUDLEY D HAYNES 
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 
6.	DATE OF BIRTH: DEC 27, 1836 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 76YRS 6DS  
8.	OCCUPATION (a.) Trade, profession or particular kind of work: FARMER 
(b.)  General nature of industry business or establishment which employed: FARM WORK  
9.	BIRTHPLACE: GARFIELD, BRECK CO, KY  
10.	NAME OF FATHER: ED HAYNES 
11.	BIRTHPLACE OF FATHER: GARFIELD, BRECKINRIDGE CO, KY 
12.	MAIDEN NAME OF MOTHER: MRS --- WOODS 
13.	BIRTHPLACE OF MOTHER:  GARFIELD, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  FRANK WOODS
(Address)  GARFIELD KY
15.	Filed  1/6/1913
REGISTAR:  JOHN COMPTON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JAN 2, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date): DEC 15, 1912 TO JAN 2, 1913 
That I last saw him alive on (date):  JAN 2, 1913
And that death occurred on the date stated above at (time AM/PM): 11 AM 
THE CAUSE OF DEATH was as follows:  
LA GRIPPE
(Duration)   Years:            Months:            Days: 15  
Contributory:  
ORGANIC HEART DISEASE
(Duration)   Years:  7          Months:            Days:  
Signed (M.D.):  J.A. SANDBACH
Date: JAN 3, 1913 
Address: GARFIELD, 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: JOHNSON CEMETERY 
DATE OF BURIAL: JAN 3, 1913 
20.	UNDERTAKER:  J.W. BRUNER
ADDRESS: GARFIELD, KY 


ADDITIONAL COMMENTS/NOTES:
From Breck Co Cemeteries Book Vol 1, Dudley was married to Rhoda and they both are buried at Chalkie Cemetery.



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