************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5302
File No.  28690
Registered No:  
2.	FULL NAME:  Annie Johnson
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  1 – 6, 1895
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  18 yrs  11 mos  2 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Wife
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Garfield, Ky
10.	NAME OF FATHER:  Offallow Meadow
11.	BIRTHPLACE OF FATHER:  Hardinsburg, Ky
12.	MAIDEN NAME OF MOTHER:  Lydda Hall
13.	BIRTHPLACE OF MOTHER:  Garfield, Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Roy Keneday
(Address)  Garfieldl, Ky
15.	Filed  Nov. 9, 1913
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  11 – 8, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  10 – 13, 1913 to 11 – 8, 1913
That I last saw him/her alive on (date):  11 – 8, 1913
And that death occurred on the date stated above at (time AM/PM):  6 a.m.
THE CAUSE OF DEATH was as follows:  Chronic Brights Disease

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

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E. C. Harned, M.D.
Date:  11 – 8, 1913
Address:  Garfield, 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:  Johnson Cem.
DATE OF BURIAL:  Nov. 9, 1913
20.	UNDERTAKER:  I. B. Richardson
ADDRESS:  Garfield, 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

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