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

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1.        

2.       PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pct:  HUDSON

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5316

Primary Registration District No:  

File No.  21644

Registered No: 14

3.       FULL NAME:  HOWARD, DANIEL

PERSONAL AND STATISTICAL PARTICULARS

4.       SEX:     MALE

5.       COLOR OR RACE:  WHJITE

6.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED

7.       DATE OF BIRTH: OCT 28, 1854

8.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  57 / 10 / 13

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

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

10.   BIRTHPLACE:  KENTUCKY

11.   NAME OF FATHER:  JAMES HOWARD

12.   BIRTHPLACE OF FATHER:  KY

13.   MAIDEN NAME OF MOTHER:  POWELL

14.   BIRTHPLACE OF MOTHER:  KY

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

(Informant)  RICHARD MERCER

(Address)  MADRID, KY

16.   Filed  

REGISTAR:  

MEDICAL CERTIFICATE OF DEATH

17.   DATE OF DEATH:  SEP 11, 1912

18.   I HEREBY CERTIFY, That I attended deceased from (date):  JUN 15, 1912 to . . . 

That I last saw him/her alive on (date):  JUN 15, 1912

And that death occurred on the date stated above at (time AM/PM):  5 PM

THE CAUSE OF DEATH was as follows:  DIABETES MELLITUS

 

(Duration)   Years:      1      Months:   6         Days:  

Contributory:  SCIRRHOSIS LIVER

 

(Duration)   Years:    28        Months:            Days:  

Signed (M.D.):  S.J. HALL

Date:  SEP 12, 1912

Address:  CONSTANTINE

19.   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:  

20.   PLACE OF BURIAL OR REMOVAL:  COYLES CEM

DATE OF BURIAL:  9/12/1912

21.   UNDERTAKER:  HUGH JONES

ADDRESS:  LEITCHFIELD, KY

 




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Copyright.  All rights reserved.
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http://www.usgwarchives.net/ky/kyfiles.html
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