************************************************************************
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.:  GLEN DEAN

Inc Town:  GLEN DEAN

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  30163

Registered No:  

2.       FULL NAME:  MATTINGLY, NANCY MARGARET

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  FEMALE

4.       COLOR OR RACE:  WHITE

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

6.       DATE OF BIRTH:  SEP 11, 1911

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  6 / 1 / 26

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

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

9.       BIRTHPLACE:  GLEN DEAN, BRECKINRIDGE CO

10.   NAME OF FATHER:  J.R. MATTINGLY

11.   BIRTHPLACE OF FATHER:  BRECKINRIDGE

12.   MAIDEN NAME OF MOTHER:  LILLIE HOOK

13.   BIRTHPLACE OF MOTHER:  BRECKINRIDGE

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

(Informant)  J.R. MATTINGLY

(Address)  GLEN DEAN

15.   Filed  DEC 15, 1911

REGISTAR:  E.L. ROBERTSON

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  NOV 7, 1911   [DELAYED]

17.   I HEREBY CERTIFY, That I attended deceased from (date):  OCT 29, 1911 to NOV 6, 1911

That I last saw him/her alive on (date):  NOV 6, 1911

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

THE CAUSE OF DEATH was as follows:  TYPHOID FEVER

 

(Duration)   Years:            Months:            Days:  15

Contributory:  PNEUMONIA

 

(Duration)   Years:            Months:            Days:  4

Signed (M.D.):  R.T. DEMPSTER

Date:  NOV 7, 1911

Address:  GLEN DEAN

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:  HARDINSBURG

DATE OF BURIAL:  NOV 8, 1911

20.   UNDERTAKER:  SHEERAN & BRO

ADDRESS:  KIRK, KY


************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************