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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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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hudson, KY
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:   5316
Primary Registration District No:  
File No.  11581
Registered No:  10
2.	FULL NAME:  LeGrand, Beattrice
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  female
4.	COLOR OR RACE:  white
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6.	DATE OF BIRTH:  Nov 11, 1909
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1yrs  6 mos.  7 ds. 
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:   Hudson, KY
10.	NAME OF FATHER:  Mason B. LeGrand
11.	BIRTHPLACE OF FATHER:  Hudson, KY
12.	MAIDEN NAME OF MOTHER:  Ida Quiggins
13.	BIRTHPLACE OF MOTHER:  Eveleigh, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  M. B. LeGrand
(Address)  Hudson, KY
15.	Filed  5/25/1911
REGISTAR:  J. H. Comer
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  5/18/1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  May 5, 1911 to May 17, 1911
That I last saw him/her alive on (date):  May 17, 1911  
And that death occurred on the date stated above at (time AM/PM):  6 a.m.
THE CAUSE OF DEATH was as follows:  
Menningeal Hemorrhage
(Duration)   Years:            Months:            Days:  10
Contributory:  Pertussis

(Duration)   Years:            Months:    2        Days:  17
Signed (M.D.):  S. J. Hall
Date:  5/19/1911
Address:  Constantine
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:  Hudson Graveyard
DATE OF BURIAL:  May 19, 1911
20.	UNDERTAKER:  E. A. Stone
ADDRESS:  Hardin Springs, KY

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Copyright.  All rights reserved.
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