************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: Brechinridge Vot. Pol.: 5306 Inc Town: C City: Cloverport No. St. Ward: 2nd Registration District No.: 131 Primary Registration District No: 2065 File No. 3587 Registered No: 99 2. FULL NAME: Gladys May Jarboe PERSONAL AND STATICAL PARTICULARS 3. SEX: Female 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Single 6. DATE OF BIRTH: Dec 19, 1912 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 1 mos 28 ds 8. OCCUPATION (a.) Trade, profession or particular kind of work: none (b.) General nature of industry business or establishment which employed: none 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: Wm Jarboe 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Annie Weatherholt 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Jake W. Weatherholt (Address) Cloverport, Ky 15. Filed Feby 17, 1913 REGISTAR: J. C. Nolte MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Feb 17, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): Feb. 8, 1913 to Feb. 17, 1913 That I last saw him/her alive on (date): Feb. 16, 1913 And that death occurred on the date stated above at (time AM/PM): 5:30 A.M. THE CAUSE OF DEATH was as follows: Broncial Pnemonia (Duration) Years: Months: Days: 9 Contributory: (Duration) Years: Months: Days: Signed (M.D.): E. C. McDonald M.D. Date: Feb 17, 1913 Address: Cloverport, 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: S. Ron Breckinridge Co., Ky DATE OF BURIAL: Feb. 18, 1913 20. UNDERTAKER: M. Hamman Sons ADDRESS: Cloverport, 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 ************************************************************************