************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: MCDANIELS Inc Town: City: No. 18 St. Ward: Registration District No.: Primary Registration District No: File No. 270 Registered No: 2. FULL NAME: LAMPTON, DAUGHTER PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: INFANT 6. DATE OF BIRTH: JAN 5, 1911 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 2 HRS 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: BRECKINRIDGE COUNTY 10. NAME OF FATHER: ELMER C. LAMPTON 11. BIRTHPLACE OF FATHER: BRECKINRIDGE CO 12. MAIDEN NAME OF MOTHER: VERNA MCCOY LAMPTON 13. BIRTHPLACE OF MOTHER: BRECKINRIDGE CO 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) (Address) 15. Filed JAN 6, 1911 REGISTAR: M.M. JARBOE MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JAN 5, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): JAN 5, 1911 to JAN 5, 1911 That I last saw him/her alive on (date): JAN 5, 1911 And that death occurred on the date stated above at (time AM/PM): 9 PM THE CAUSE OF DEATH was as follows: GENERAL DEBILITY – CHILD LIVED ONLY 2 HOURS – SEEMED TO LACK NECESSARY VITALITY (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.B. LAMPTON Date: JAN 6, 1911 Address: MCDANIELS 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: ANTIOCH CEM DATE OF BURIAL: 20. UNDERTAKER: ADDRESS: ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************