1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: 12
Inc Town: Irvington
City: Irvington
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5312
File No. 29817
Registered No: 5312
1. FULL NAME: Paul Arthur LeGrand
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: May 5, 1911
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 1yr7mos21ds
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Irvington, Ky
9. NAME OF FATHER: Jas. LeGrand
10. BIRTHPLACE OF FATHER: Irvington, Ky
11. MAIDEN NAME OF MOTHER: Mildred Adams
12. BIRTHPLACE OF MOTHER: Indiana
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) James LeGrand
(Address) Irvington, Ky
14. Filed Dec 28, 1912
REGISTAR: DW Henry
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: December 27, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Dec 20, 1912 to Dec 27, 1912
That I last saw him/her alive on (date): Dec 26, 1912
And that death occurred on the date stated above at (time AM/PM): 12:30 M
THE CAUSE OF DEATH was as follows:
Intersusception of bowels
(Duration)
Years:
Months:
Days:
Signed (M.D.): S.P. Parks
Date: Dec 27, 1912
Address: S.P. Parks (?)
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: Irvington, Ky
DATE OF BURIAL: Dec 27, 1912
19. UNDERTAKER: GT Marshall & Son
ADDRESS: Irvington, Ky