PLACE OF DEATH

County:  BRECKINRIDGE

Vot. Pol.:  HARDINSBURG

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  17182

Registered No: 45 

1.       FULL NAME:  JARBOE, LULA

PERSONAL AND STATICAL PARTICULARS

2.       SEX:  FEMALE

3.       COLOR OR RACE:  WHITE

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

5.       DATE OF BIRTH:  DEC 3, 1883

6.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  28 / 7 / 9

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

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

8.       BIRTHPLACE:  KENTUCKY

9.       NAME OF FATHER:  ROBT MATTINGLY 

10.   BIRTHPLACE OF FATHER:  KENTUCKY

11.   MAIDEN NAME OF MOTHER:  POWERS, ELLEN

12.   BIRTHPLACE OF MOTHER:  KENTUCKY

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

(Informant)  ARTHUR JARBOE

(Address)  HARDINSBURG, KY

14.   Filed  JUL 13, 1911

REGISTAR:  W.B. LENNON

MEDICAL CERTIFICATE OF DEATH

15.   DATE OF DEATH:  JUL 17, 1911

16.   I HEREBY CERTIFY, That I attended deceased from (date):  1 JAN 1911 to JUL 12, 1911

That I last saw him/her alive on (date):  JUL 12, 1911

And that death occurred on the date stated above at (time AM/PM):  2 AM  [9 AM SCRATCHED OUT]

THE CAUSE OF DEATH was as follows:  DIABETES

 

(Duration)   Years:            Months:            Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  JOHN E. KINCHELOR

Date:  JUL 13, 1911

Address:  HARDINSBURG, KY

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:  ST ROMUALDS CEMETERY

DATE OF BURIAL:  JUL 13, 1911

19.   UNDERTAKER:  PETE SHEERAN & CO

ADDRESS:  KIRK, KY

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

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

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