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

1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  STEPHENSPORT
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  23681
Registered No: 42 
2. FULL NAME:  MCKAUGHN, ARCHIE B.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  MAY 28, 1845
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  68 YR 3 MO 8 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  LABORER
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  BRECKINRIDGE CO.
10. NAME OF FATHER:  CARL MCKAUGHN
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  FRANCIS A. HUCKLEBY
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  GEORGE E. SHIVELY
(Address)  STEPHENSPORT, KY
15. Filed  SEPT 6, 1913
REGISTRAR:  R. A. HULLMANN
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  SEPT 6, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  SEPT 5, 1913
That I last saw him/her alive on (date):  SEPT 5, 1913
And that death occurred on the date stated above at (time AM/PM):  11:30 AM
THE CAUSE OF DEATH was as follows:  RUPTURE OF BOWELS, FOLLOWED BY SHOCK, AS RESULT OF DIRECT INJURY

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  GEORGE E. SHIVELY
Date:  SEPT 8 1913
Address:  STEPHENSPORT, 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:  STEPHENSPORT, KY
DATE OF BURIAL:  SEPT. 7, 1913
20. UNDERTAKER:  U. J. SCHOPP
ADDRESS:  STEPHENSPORT, KY

************************************************************************
 
File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net
 
************************************************************************