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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  GLEN DEAN
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5319
Primary Registration District no:  19
File No.  17908
Registered No:  
2. FULL NAME:  MCDANIELS, JULIA
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  COLORED
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6. DATE OF BIRTH:  1847
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  66
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  MEADE CO., KY
10. NAME OF FATHER:  JOHN ALEXANDER
11. BIRTHPLACE OF FATHER:  MEADE CO., KY
12. MAIDEN NAME OF MOTHER:  UNKNOWN
13. BIRTHPLACE OF MOTHER:  UNKNOWN
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  SOLOMON DEAN
(Address)  GLEN DEAN, KY
15. Filed  JULY 18, 1913
REGISTRAR:  MRS. MOLLY DEMPSTER
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JULY 14, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  APRIL 28, 1913
That I last saw him/her alive on (date):  JULY 13, 1913
And that death occurred on the date stated above at (time AM/PM):  7 AM
THE CAUSE OF DEATH was as follows:  PARALYSIS FROM CEREBRAL HEMORRHAGE

(Duration)   Years:            Months:      2      Days:  16
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R. G. DEMPSTER
Date:  JULY 14, 1913
Address:  GLEN DEAN, 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:  MCQUADY, KY
DATE OF BURIAL:  JULY 18, 1913
20. UNDERTAKER:  H. WILSON CO.
ADDRESS:  GLEN DEAN, KY

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