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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward:  3rd
Registration District No.:  130
Primary Registration District No:  5302
File No.  9441
Registered No:  
2.	FULL NAME:  KISSINGER, ROY
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  MAR 23, 1891
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  23 / 0 / 21
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  	NOEL KISSINGER
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  NANCY RHOADS
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  CARL MEADOR
(Address)  HARDINSBURG
15.	Filed  APR 14, 1914
REGISTAR:  W.B. LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APR 13, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  FEB 1914 to APR 3, 1914
That I last saw him/her alive on (date):  MAR 1, 1914
And that death occurred on the date stated above at (time AM/PM):  7 PM
THE CAUSE OF DEATH was as follows:  PULMONARY TUBERCULOSIS
(Duration)   Years:            Months:     4       Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  JOHN E. KINCHELOE
Date:  APR 14, 1914
Address:  HARDINSBURG
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  2 mos
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  DON'T KNOW
Former or usual residence:  CUSTER
19.	PLACE OF BURIAL OR REMOVAL:  HENRY JOLLY CEM
DATE OF BURIAL:  APR 14, 1914
20.	UNDERTAKER:  B.F. BEARD & SONS
ADDRESS:  HARDINSBURG


ADDITIONAL COMMENTS/NOTES:




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