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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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PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pol.:  MOOLEYVILLE

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  17195

Registered No: 5310 

1.       FULL NAME:  HYLTONE, ERNIE  

PERSONAL AND STATICAL PARTICULARS

2.       SEX:  MALE

3.       COLOR OR RACE:  WHITE

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

5.       DATE OF BIRTH:  DEC 2, 1906

6.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  4 / 7 / 14

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

(b.)  General nature of industry business or establishment which employed:  NONE

8.       BIRTHPLACE:  BRECKINRIDGE CO

9.       NAME OF FATHER:  HENRY HILTON

10.   BIRTHPLACE OF FATHER:  VIRGINIA

11.   MAIDEN NAME OF MOTHER:  EDNA BOLIN

12.   BIRTHPLACE OF MOTHER:  VIRGINIA

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

(Informant)  W.A. VESSELS

(Address)  LAHANT

14.   Filed  JUL 16, 1911

REGISTAR:  JAMES CUNNINGHAM

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  JUL 16, 1911

16.   I HEREBY CERTIFY, That I attended deceased from (date):  JUL 4, 1911 to JUL 15, 1911

That I last saw him/her alive on (date):  JULY 15, 1911

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

THE CAUSE OF DEATH was as follows:  ABCESS OF THE BRAIN

 

(Duration)   Years:            Months:            Days:  12

Contributory:  INJURY ACCIDENTAL FALL FROM HIGH CHAIR

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  D.S. SPIRE

Date:  JUL 16, 1911

Address:  MOOLEYVILLE

17.   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:  

18.   PLACE OF BURIAL OR REMOVAL:  ROME BURIAL

DATE OF BURIAL:  JUL 16, 1911

19.   UNDERTAKER:  C.H. HARDESTY

ADDRESS:  LEHANT, KY


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