************************************************************************
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.:  STEPHENSPORT
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  9519
Registered No:  
2.	FULL NAME:  HORSLEY, JOHN
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6.	DATE OF BIRTH:  JAN. 1, 1831
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  82 YR. 3 MO. 6 DA.
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  FARMING
9.	BIRTHPLACE:  BRECKINRIDGE CO., KY
10.	NAME OF FATHER:  CHRISTOPHER HORSLEY
11.	BIRTHPLACE OF FATHER:  VA
12.	MAIDEN NAME OF MOTHER:  DICIE CARMAN
13.	BIRTHPLACE OF MOTHER:  VA
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  ALBERT HORSLEY
(Address)  GUMLALE (?)
15.	Filed  APR 11 1913
REGISTAR:  R. A. SHELLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APRIL 7, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MARCH 14, 1913
That I last saw him/her alive on (date):  MARCH 14, 1913
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  ORGANIC HEART TROUBLE

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  WILLIAM L. MILNER
Date:  APRIL 10, 1913
Address:  UNION STAR, 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:  SAMPLE GRAVEYARD, N. BRUMFIELD
DATE OF BURIAL:  APRIL 17, 1913
20.	UNDERTAKER:  W. J. SCHOPP
ADDRESS:  STEPHENSPORT, KY


ADDITIONAL COMMENTS/NOTES:




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

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

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