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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.:  Curtis, Ky

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5315

Primary Registration District No:  

File No.  435

Registered No:  20

2.       FULL NAME:  Ben Macy

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  male

4.       COLOR OR RACE:  white

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married

6.       DATE OF BIRTH:  Oct 1, 1841

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  70 years, 3 months, 24 days

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  farmer

(b.)  General nature of industry business or establishment which employed:  farm work

9.       BIRTHPLACE:  Garfield, Breckinridge Co., Ky

10.   NAME OF FATHER:  Elihue Macy

11.   BIRTHPLACE OF FATHER:  Garfield, Breckinridge Co., Ky

12.   MAIDEN NAME OF MOTHER:  Patsy Brewington

13.   BIRTHPLACE OF MOTHER:  Garfield, Breckinridge Co., Ky

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  Nathaniel Whitworth

(Address)  Garfield, Ky

15.   Filed  Jan. 26, 1912

REGISTAR:  R. O. Penick

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Jan 24, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 18, 1912 to Jan 24, 1912

That I last saw him/her alive on (date):  Jan 24, 1912

And that death occurred on the date stated above at (time AM/PM):  3 pm

THE CAUSE OF DEATH was as follows:  Lobar Pneumonia

 

(Duration)   Years:            Months:            Days:  6

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  J. A. Sandbach

Date:  Jan 24, 1912

Address:  Garfield, Ky

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:  Johnson Grave Yard [Johnson Cemetery #2]

DATE OF BURIAL:  Jan 25, 1912

20.   UNDERTAKER:  I. B. Richardson

ADDRESS:  Garfield, Ky




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Copyright.  All rights reserved.
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