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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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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BALLTOWN
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  14283
Registered No: 5 
2. FULL NAME:  KEENAN, MRS. JANE MATTHEWS
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6. DATE OF BIRTH:  JUN 1, 1932
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  79 / 0 / 22
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:  SAMUEL MATTHEWS
11. BIRTHPLACE OF FATHER:  KENTUCKY
12. MAIDEN NAME OF MOTHER:  NELLIE MAXWELL
13. BIRTHPLACE OF MOTHER:  KENTUCKY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JAMES KEENAN
(Address)  MATTINGLY, KY
15. Filed  JUN 29, 1911
REGISTAR:  FRED FRANK
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JUN 22, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  MAY 10, 1911 to 22 JUN 1911
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  SOFTENING OF BRAIN

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  WILLIAM HOWARD
Date:  UNDATED
Address:  MATTINGLY, 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:  - FAMILY BURYING GROUND, BRECKINRIDGE COUNTY
DATE OF BURIAL:  JUN 23, 1911
20. UNDERTAKER:  M. HAMMON & SON
ADDRESS:  CLOVERPORT

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