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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.  6354
Registered No: 138  
2.	FULL NAME:  HORSLEY, WILLIAM CHESTER
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  DEC. 15, 1912
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  2 MO 24 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:  WILLIAM ARTHUR HORSLEY
11.	BIRTHPLACE OF FATHER:  GARFIELD, KY
12.	MAIDEN NAME OF MOTHER:  MAY LYONS
13.	BIRTHPLACE OF MOTHER:  CUSTIS, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  ARTHUR HORSLEY
(Address)  GARFIELD, KY
15.	Filed  MARCH 10, 1913
REGISTAR:  W. B. LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MARCH 9, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEC. 15, 1912
That I last saw him/her alive on (date):  MARCH 9, 1913
And that death occurred on the date stated above at (time AM/PM):  7 AM
THE CAUSE OF DEATH was as follows:  CONGENITAL DEBILITY

(Duration)   Years:            Months:   2         Days:  20
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. SANDBACH
Date:  MARCH 10, 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, KY
DATE OF BURIAL:  MARCH 10, 1913
20.	UNDERTAKER:  J. B. RICHARDSON
ADDRESS:  GARFIELD, KY


ADDITIONAL COMMENTS/NOTES:




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