1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  MOOK
Inc Town:  
City:  
No.  
St.  
Ward:
Registration District No.:  5317
Primary Registration District No:  
File No.  24891
Registered No:  
2. FULL NAME:  MILAM, RAYMOND H.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  SEPT. 12, 1914
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  5 MIN
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  LOCUST HILL, KY
10. NAME OF FATHER:  HENRY G. MILAM
11. BIRTHPLACE OF FATHER:  WESTVIEW, KY
12. MAIDEN NAME OF MOTHER:  NELIA G. FRANK
13. BIRTHPLACE OF MOTHER:  CANEYVILLE, KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MURRAY BUTLER
(Address)  LOCUST HILL, KY
15. Filed  
REGISTRAR:  
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  SEPT. 12, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  SEPT. 12, 1914
That I last saw him/her alive on (date):  SEPT. 12, 1914
And that death occurred on the date stated above at (time AM/PM):  7 PM
THE CAUSE OF DEATH was as follows:  CONGENITAL DEBILITY

(Duration)   Years:            Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. SANDBACH
Date:  SEPT. 13, 1914
Address:  GARFIELD, 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:  
DATE OF BURIAL:  
20. UNDERTAKER:  
ADDRESS: