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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  UNION STAR
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  5309
File No.  23825
Registered No: 13 
2.	FULL NAME:  KEYS, BENJAMIN FRANKLIN
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6.	DATE OF BIRTH:  JUN 4, 1841
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  74 / 4 / 29
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  CARPENTER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  EDWARD KEYS
11.	BIRTHPLACE OF FATHER:  VIRGINIA
12.	MAIDEN NAME OF MOTHER:  SUSAN CORK
13.	BIRTHPLACE OF MOTHER:  VIRGINIA
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  GEORGE HESSLER
(Address)  UNION STAR
15.	Filed  OCT 3, 1915
REGISTAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 3, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  SEP 26, 1915 to OCT 3, 1915
That I last saw him/her alive on (date):  OCT 2, 1915
And that death occurred on the date stated above at (time AM/PM):  1:40 PM
THE CAUSE OF DEATH was as follows:  SEPTICEMIA
(Duration)   Years:            Months:            Days:    7
Contributory:  TUBERCULE ABSCESS
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  D.S. SPHIRO
Date:  OCT 3, 1915
Address:  MOOLEYVILLE
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:  SHELLMAN GRAVEYARD
DATE OF BURIAL:  OCT 4, 1915
20.	UNDERTAKER:  C.A. TINIUS
ADDRESS:  STEPHENSPORT


ADDITIONAL COMMENTS/NOTES:




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