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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Glen Dean
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  132
Primary Registration District No:  5319
File No.  11265
Registered No:  
2.	FULL NAME:  Limer, Velma
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  female
4.	COLOR OR RACE:  white
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6.	DATE OF BIRTH:  Oct. 5, 1909
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 yrs  5 mos  16 ds. 
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Infant
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Breckinridge County
10.	NAME OF FATHER:  Zen Limer
11.	BIRTHPLACE OF FATHER:  Kentucky
12.	MAIDEN NAME OF MOTHER:  Mathus Burden
13.	BIRTHPLACE OF MOTHER:  Kentucky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J. I. Limer
(Address)  Glen Dean, KY
15.	Filed  Apr. 21, 1911
REGISTAR:  E. L. Robertson
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Apr. 21. 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Apr. 20, 1911 to Apr. 21, 1911 
That I last saw him/her alive on (date):  April 21, 1911
And that death occurred on the date stated above at (time AM/PM):  3 p.m.
THE CAUSE OF DEATH was as follows:  
Pneumonia
(Duration)   Years:            Months:            Days:  3
Contributory:  
Measles
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R. T. Dempster
Date:  Apr. 21, 1911
Address:  Glen Dean
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:  Glen Dean Cemetery
DATE OF BURIAL:  April 22, 1911
20.	UNDERTAKER:  W. C. Moorman
ADDRESS:  

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