1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg, Ky
Inc Town:
City:
No.
St.
Ward: 3rd
Registration District No.: 130
Primary Registration District No: 5303
File No. 19019
Registered No: 169
1. FULL NAME: Bertram Kerr
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: Sept 27, 1911
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 10mos6ds
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Elemire Hoyt Kerr
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: <  > Logsdon
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) James Logsdon
(Address) <   > Ky
14. Filed Aug 2, 1912
REGISTAR: WB Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Aug 2, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): July 28, 1912 to Aug 2, 1912
That I last saw him/her alive on (date): Aug 1, 1912
And that death occurred on the date stated above at (time AM/PM): 3 ½ AM (or 8 ½)
THE CAUSE OF DEATH was as follows:
Entro Colitis
(Duration)
Years:
Months:
Days: 10
Contributory: stomatitis
Signed (M.D.): Allen M Kincheloe
Date: 3-2-1912
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: Brickey Cemetery
DATE OF BURIAL: Aug 3, 1912
19. UNDERTAKER: BF Beard & Co
ADDRESS: Hardinsburg, Ky