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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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PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BALL TOWN
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  14282
Registered No: 4 
1. FULL NAME:  LANDERS, JEREMIAH
PERSONAL AND STATICAL PARTICULARS
2. SEX:  MALE
3. COLOR OR RACE:  WHITE
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
5. DATE OF BIRTH:  MAY 1, 1884
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  27 / 1 / 7
7. OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  GENERAL FARM WORK
8. BIRTHPLACE:  KENTUCKY
9. NAME OF FATHER:  JACOB LANDERS
10. BIRTHPLACE OF FATHER:  KENTUCKY
11. MAIDEN NAME OF MOTHER:  MELVINA BUCHANON
12. BIRTHPLACE OF MOTHER:  KENTUCKY
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J.T. LANDERS
(Address)  288 ADAMS ST, LOUISVILLE, KY
14. Filed 9 JUN 1911 
REGISTAR:  FRED FRANK
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH:  JUN 8, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date):  MAY 28, 1911 to JUN 8, 1911
That I last saw him/her alive on (date):  JUN 6, 1911
And that death occurred on the date stated above at (time AM/PM):  12:30 AM
THE CAUSE OF DEATH was as follows:   HEMMORHAGE FROM LUNGS FOLLOWING GUNSHOT WOUND

(Duration)   Years:            Months:            Days:  
Contributory:  HOMICIDAL

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C.R. LIGHTFOOT
Date:  JUN 8, 1911
Address:  CLOVERPORT
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:  TAR FORK BURYING GROUND
DATE OF BURIAL:  JUN 9, 1911
19. UNDERTAKER:  M. HAMMON	
ADDRESS:  CLOVERPORT

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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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************************************************