1.       PLACE OF DEATH

County: Breckinridge 

Vot. Pol.: Balltown

Inc Town:

City:

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 14284

Registered No: 6

2.       FULL NAME: Jesse Noble Hinton

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Single

6.       DATE OF BIRTH: Feb 11, 1911

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 4 mos 11 da

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  

(b.)  General nature of industry business or establishment which employed:

9.       BIRTHPLACE: Breckinridge Co KY

10.   NAME OF FATHER: John E Hinton

11.   BIRTHPLACE OF FATHER: Breckinridge County KY

12.   MAIDEN NAME OF MOTHER: Bettie Brickey

13.   BIRTHPLACE OF MOTHER: Breckinridge County KY

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Frank Burden

(Address) Mattingly KY

15.   Filed June 28, 1911

REGISTAR: Fred Frank

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: June 24, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date): June 18, 1911 to June 24, 1911

That I last saw him/her alive on (date): June 24, 1911

And that death occurred on the date stated above at (time AM/PM): 4 PM

THE CAUSE OF DEATH was as follows: Cholera Infantum

 

(Duration)

Years:

Months:

Days:

Contributary: Bottle feeding and unsanitary surroundings

(Duration)

Years: 4

Months:

Days:

Signed (M.D.): William Howard

Date: 

Address: Mattingly

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 Tarfork, KY

DATE OF BURIAL: June 24, 1911

20.   UNDERTAKER: M Hammon

ADDRESS: Cloverport KY