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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Glen Dean
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  3598
Registered No:  5319
2.	FULL NAME:  John Wesley Jarboe
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6.	DATE OF BIRTH:  Dec. 11, 1842
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  70 yrs  2 mos  13 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Kentucky
10.	NAME OF FATHER:  Samuel Jarboe
11.	BIRTHPLACE OF FATHER:  Ky
12.	MAIDEN NAME OF MOTHER:  Alice Blanford
13.	BIRTHPLACE OF MOTHER:  Ky.
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Frank Jarboe
(Address)  Axtel, Ky
15.	Filed  Mar. 4, 1913
REGISTAR:  Mrs. Molly Dempster
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Feb. 27, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 21st, 1913 to Feb. 27, 1913
That I last saw him/her alive on (date):  Feb. 27, 1913
And that death occurred on the date stated above at (time AM/PM):  3 a.m.
THE CAUSE OF DEATH was as follows:  Lagripp and also Lobar pneumonia which began about 36 hours before death.

(Duration)   Years:            Months:            Days:  5
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. B. Lampton M.D.
Date:  Feb. 27, 1913
Address:  McDaniels, 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:  McDaniels Cemetary
DATE OF BURIAL:  Feb. 27, 1913
20.	UNDERTAKER:  H. Wilson & Co
ADDRESS:  Glen Dean, Ky


ADDITIONAL COMMENTS/NOTES:




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