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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  23685
Registered No:  40
2. FULL NAME:  MAY, MARY L.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  APRIL 19, 1912
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 YR 4 MO 24 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  JAMES MAY
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  BERTHA WILSON
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JIM HARRIS
(Address)  IRVINGTON, KY
15. Filed  SEPT 1913
REGISTRAR:  D. W. HENRY
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  SEPT 18, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  SEPT 17, 1913
That I last saw him/her alive on (date):  SEPT 17, 1913
And that death occurred on the date stated above at (time AM/PM):  2 AM
THE CAUSE OF DEATH was as follows:  INTESTINAL TUBERCULOSIS

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  P. H. NEVITT
Date:  SEPT. 181, 1913
Address:  IRVINGTON, 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:  WEBSTER, KY
DATE OF BURIAL:  SEPT 19, 1913
20. UNDERTAKER:  G. T. MARSHALL AND SON
ADDRESS:  IRVINGTON, KY

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net
 
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