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

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

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

1.       PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pct:  BALLTOWN

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  5321

File No.  16172

Registered No: 

2.       FULL NAME:  HUFF, DAUGHTER

PERSONAL AND STATISTICAL PARTICULARS

3.       SEX:     FEMALE

4.       COLOR OR RACE:  WHITE

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

6.       DATE OF BIRTH: APR 22, 1912

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  STILLBORN

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

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

9.       BIRTHPLACE:  BRECKINRIDGE

10.   NAME OF FATHER:  JESS HUFF

11.   BIRTHPLACE OF FATHER:  HANCOCK CO

12.   MAIDEN NAME OF MOTHER:  MAGGIE SANDERS

13.   BIRTHPLACE OF MOTHER:  HANCOCK CO

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

(Informant)  JESS HUFF

(Address)  EASTON, KY

15.   Filed  APR 24, 1912

REGISTAR:  E.L. ROBERTSON

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  APR 22, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  APR 22, 1912

That I last saw him/her alive on (date):  

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

THE CAUSE OF DEATH was as follows:  STILLBORN

 

(Duration)   Years:            Months:            Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  

Date:  APR 22, 1912   [DELAYED]

Address:  FORDSVILLE, 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:  “WASN’T FURNISHED WHEN SENT TO ME”

DATE OF BURIAL:  

20.   UNDERTAKER:  

ADDRESS:  

 
 




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