************************************************************************
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.: HARDINSBURG 
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.: 130 
Primary Registration District No: 5304 
File No.  26153
Registered No:  
2.	FULL NAME: THOMAS EDWARDS MARTIN  
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE: WHITE 
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH: OCT 2, 1913 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 1DAY 
8.	OCCUPATION (a.) Trade, profession or particular kind of work: INFANT  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  JOHN R MARTIN
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  TEENY (TINA) BASHAM
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  THOS WITHERS
(Address)  HARDINSBURG
15.	Filed  OCT 4, 1913
REGISTAR:  WB LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: OCT 3, 191_ 
17.	I HEREBY CERTIFY, That I attended deceased from (date): OCT 2, 1913 TO OCT 3, 1913 
That I last saw him alive on (date):  OCT 2, 1913
And that death occurred on the date stated above at (time AM/PM): 3PM 
THE CAUSE OF DEATH was as follows:  
ATELECTASIS
(Duration)   Years:            Months:            Days: 1 
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  JNO E KINCHELOE
Date: OCT 3, 1913 
Address:  HARDINSBURG, 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: FAIR VIEW CEMETERY 
DATE OF BURIAL: OCT 4, 1913 
20.	UNDERTAKER: PETE SHEERAN BROS & CO
ADDRESS:  KIRK, KY


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

************************************************************************