************************************************************************
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.:  5306

Inc Town:  

City:  CLOVERPORT

No.  

St.  

Ward:  

Registration District No.:  131

Primary Registration District No:  2065

File No.  20123

Registered No: 34 

2.        FULL NAME:  MAY, HENRY JACOB Sr.

PERSONAL AND STATICAL PARTICULARS

3.        SEX:  MALE

4.        COLOR OR RACE:  WHITE

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

6.        DATE OF BIRTH:  AUG 12, 1836

7.        AGE  (yr. mo. da) (If less than 1 day, hours or min?):  75 / 0 / 11

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

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

9.        BIRTHPLACE:  PRUSSIA

10.     NAME OF FATHER:  JACOB MAY

11.     BIRTHPLACE OF FATHER:  PRUSSIA

12.     MAIDEN NAME OF MOTHER:  ELIZAZBETH WALTER

13.     BIRTHPLACE OF MOTHER:  PRUSSIA

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

(Informant)  CHARLES MAY Sr

(Address)  CLOVERPORT

15.     Filed  AUG 24, 1911

REGISTAR:  J..C. NOLTE

MEDICAL CERTIFICATE OF DEATH

16.     DATE OF DEATH:  AUG 23, 1911

17.     I HEREBY CERTIFY, That I attended deceased from (date):  MAR 1, 1911 to AUG 23, 1911

That I last saw him/her alive on (date):  AUG 22, 1911

And that death occurred on the date stated above at (time AM/PM):  9:30 AM

THE CAUSE OF DEATH was as follows:  CHRONIC BREUCHYMATOUS NEPHRITIS

 

(Duration)   Years:            Months:            Days:  

Contributory:  ACUTE UREMIA

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  C.R. LIGHTFOOT

Date:  AUG 23, 1911

Address:  CLOVERPORT

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:  CLOVERPORT

20.     DATE OF BURIAL:  AUG 24, 1911

21.     UNDERTAKER:  M. HAMMON & SONS

ADDRESS:  CLOVERPORT

 

TRANSCRIBER’S NOTE:  

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