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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.:  5307

Inc Town:  Cloverport, KY

City:  

No.  

St.  

Ward:  3rd

Registration District No.:  131

Primary Registration District No:  2065

File No.  11890

Registered No:  62

2.       FULL NAME:  Wm Golden Mattingly

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  male

4.       COLOR OR RACE:  white

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

6.       DATE OF BIRTH:  May 7, 1909

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

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  none

(b.)  General nature of industry business or establishment which employed:  none

9.       BIRTHPLACE:  Kentucky

10.   NAME OF FATHER:  James H Mattingly

11.   BIRTHPLACE OF FATHER:  Kentucky

12.   MAIDEN NAME OF MOTHER:  Katie L Wethington

13.   BIRTHPLACE OF MOTHER:  Kentucky

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

(Informant)  Frank Rouch

(Address)  McQuady, KY

15.   Filed  May 8, 1912

REGISTAR:  J C Nolte

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  May 8, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  May 8, 1912 to May 8, 1912

That I last saw him/her alive on (date):  May 8, 

And that death occurred on the date stated above at (time AM/PM):  4 am

THE CAUSE OF DEATH was as follows:  shock from extensive scald of body

 

(Duration)   Years:            Months:            Days:  7 1/2 hours

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  A.A. Simons

Date:  May 8, 1912

Address:  Cloverport, 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:  St Rose, Breckinridge Co., KY

DATE OF BURIAL:  May 9, 1912

20.   UNDERTAKER:  M. Hamman & Son

ADDRESS:  Cloverport, KY



 
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Copyright.  All rights reserved.
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