************************************************************************ 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.: GLEN DEAN Inc Town: City: No. St. Ward: Registration District No.: 5319 Primary Registration District No: 19 File No. 30830 Registered No: 2. FULL NAME: MATTHEWS, HENRY F. PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: APR 3, 1952 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): FARMER62 / 8 / 9 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: JOE C. MATTHEWS 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: ELIZABETH FENTRESS 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) T.F. BROWN (Address) AXTEL, KENTUCKY 15. Filed DEC 14, 1914 REGISTAR: MRS. MOLLY DEMPSTER MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: DEC 12, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): DEC 7, 1914 to DEC 11, 1914 That I last saw him/her alive on (date): DEC 11, 1914 And that death occurred on the date stated above at (time AM/PM): 11 AM THE CAUSE OF DEATH was as follows: A MALIGNANT DISEASE IN THE ABDOMEN PROBABLY CANCER OF THE PANCREAS (Duration) Years: 2 Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.B. LAMPTON Date: DEC 13, 1914 Address: McDANIELS 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: ST ANTHONY'S CEM DATE OF BURIAL: DEC 13, 1914 20. UNDERTAKER: CITIZENS ADDRESS: AXTEL 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 ************************************************************************