************************************************************************ 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.: HARDINSBURG Inc Town: City: No. St. Ward: Registration District No.: 130 Primary Registration District No: 5302 File No. 21012 Registered No: 2. FULL NAME: HORSLEY, MARGARETT ESTELL PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: AUG. 5, 1909 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 4 YR 0 MO 23 DA 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: GARFIELD, KY 10. NAME OF FATHER: ARTHUR W. HORSLEY 11. BIRTHPLACE OF FATHER: GARFIELD, KY 12. MAIDEN NAME OF MOTHER: MARGRIT LYONS 13. BIRTHPLACE OF MOTHER: CUSTIS, KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) C. S. BEARD (Address) GARFIELD, KY 15. Filed AUG. 30, 1913 REGISTAR: W. B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: AUG. 28, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): 7 PM THE CAUSE OF DEATH was as follows: POISONING BY DOSE OF WOMEN'S ??? OF PARIS (ACCIDENT) (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J. A. SANDBACH Date: AUG. 28, 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: GARFIELD CEMETERY. DATE OF BURIAL: AUG. 30, 1913 20. UNDERTAKER: J. B. RICHARDSON ADDRESS: GARFIELD, 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 ************************************************************************