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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.:  Hudson

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  5316

File No.  3330

Registered No:  14

2.       FULL NAME:  Mariah Louisa McCamish

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  female

4.       COLOR OR RACE:  white

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

6.       DATE OF BIRTH:  [blank]

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  as near as known: 85 years

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

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

9.       BIRTHPLACE:  Washington Co., KY

10.   NAME OF FATHER:  Cornelius   Whitehouse

11.   BIRTHPLACE OF FATHER:  Va

12.   MAIDEN NAME OF MOTHER:  not known

13.   BIRTHPLACE OF MOTHER:  Va

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

(Informant)  F.M> McCamish

(Address)  Austimteve, Ky

15.   Filed  2/12, 1912

REGISTAR:  J.H. Comer

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Feb 11, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Feb 9, 1912 to Feb 10, 1912

That I last saw him/her alive on (date):  Feb 10, 1912

And that death occurred on the date stated above at (time AM/PM):  2 AM

THE CAUSE OF DEATH was as follows:  Angina Pectoris

 

(Duration)   Years:       2     Months:            Days:  

Contributory:  Inflamitis of age

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  J. W. & R.W. Meador

Date:  

Address:  Custer

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:  McCamish Cemetery

DATE OF BURIAL:  2/12, 1912

20.   UNDERTAKER:  J.C. Oliver

ADDRESS:  Custer, KY


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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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