************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: 5307 Inc Town: City: CLOVERPORT No. St. Ward: 3RD Registration District No.: 131 Primary Registration District No: 2065 File No. 17460 Registered No: 157 2. FULL NAME: LOVE, ROBERT HERMAN PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: JUN 11, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 21 DAYS 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: JAMES LOVE 11. BIRTHPLACE OF FATHER: INDIANA 12. MAIDEN NAME OF MOTHER: GRACE WILSON 13. BIRTHPLACE OF MOTHER: INDIANA 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) JAMES LOVE (Address) CLOVERPORT 15. Filed JUL 3, 1914 REGISTAR: J.C. NOLTE MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JUL 2, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): JUL 2, 1914 to JUL 2, 1914 That I last saw him/her alive on (date): JUL 2, 1914 And that death occurred on the date stated above at (time AM/PM): 4:50 PM THE CAUSE OF DEATH was as follows: PERTUSIS (Duration) Years: Months: Days: 21 Contributory: (Duration) Years: Months: Days: Signed (M.D.): E.C. McDONALD Date: JUL 3, 1914 Address: CLOVERPORT 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: CLOVERPORT DATE OF BURIAL: JUL 3, 1914 20. UNDERTAKER: M.HAMMON & SONS ADDRESS: CLOVERPORT ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************