************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  MOOK
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5317
Primary Registration District No:  
File No.  12275
Registered No:  21
2.	FULL NAME:  HOLLOWAY, JOE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  BLACK
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6.	DATE OF BIRTH:  FEB 21, 1832
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  79 YR 1 MO 26 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  VA
10.	NAME OF FATHER: HUGH HOLLOWAY  
11.	BIRTHPLACE OF FATHER:  VA
12.	MAIDEN NAME OF MOTHER:  UNKNOWN
13.	BIRTHPLACE OF MOTHER:  
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  (UNREADABLE)
(Address)  
15.	Filed  MAY 26, 1913
REGISTAR:  V. G. GOODMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 26, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date): May 23, 1913  
That I last saw him/her alive on (date):  May 25
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  

(Duration)   Years: 20         Months:            Days:  
Contributory:  High life

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  
Date:  
Address:  
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:  
DATE OF BURIAL: MAY 26, 1913
20.	UNDERTAKER:  
ADDRESS:  


ADDITIONAL COMMENTS/NOTES:
Image was in VERY poor condition.  What was legible to read was transcribed.



************************************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************