************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Mooleyville Inc Town: City: No. St. Ward: Registration District No.: 5310 Primary Registration District No: File No. 27944 Registered No: 5310 2. FULL NAME: Mrs. Bessie Mapes PERSONAL AND STATICAL PARTICULARS 3. SEX: female 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married 6. DATE OF BIRTH: Aug. 8, 1884 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 28 years, 3 months, 11 days 8. OCCUPATION (a.) Trade, profession or particular kind of work: Nurse (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: A. G. Roberts 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Letitia E. Gilliland 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) L. B. Hall (Address) Chenault, Ky 15. Filed 21 Nov 1912 REGISTAR: J. D. Cunningham per Mrs. S. R. O' Bryan MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: November 19, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): Aug. 22, 1912 to Nov. 14, 1912 That I last saw him/her alive on (date): Nov. 14, 1912 And that death occurred on the date stated above at (time AM/PM): 8:11 pm THE CAUSE OF DEATH was as follows: Tuberculosis acute Miliary (Duration) Years: 2 Months: Days: 27 Contributory: Tubercula Kidney (Duration) Years: Months: 5 Days: Signed (M.D.): D. S. Spire, MD Date: Nov 20, 1912 Address: Mooleyville 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: Gethsemane DATE OF BURIAL: Nov. 21, 1912 20. UNDERTAKER: R. T. Frymire ADDRESS: Chenault, Ky ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************