************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: Breckinridge Vot. Pol.: 530 Inc Town: City: Cloverport KY No. St. Ward: 3 Registration District No.: 131 Primary Registration District No: 5307 File No. 20128 Registered No: 35 2. FULL NAME: Delia Miller PERSONAL AND STATICAL PARTICULARS 3. SEX: Female 4. COLOR OR RACE: Colored 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: 1 Oct 1849 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 63 yrs 2 mos 8. OCCUPATION (a.) Trade, profession or particular kind of work: House Keeper (b.) General nature of industry business or establishment which employed: General House Work 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: Nat Moorman 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Beckie Jackson 13. BIRTHPLACE OF MOTHER: Louisiana 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Carrie Miller (Address) Cloverport Ky 15. Filed Aug 26, 1911 REGISTAR: J. C. Nolte MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Aug 26, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): May 1, 1911 to Aug 25, 1911 That I last saw her alive on (date): Aug 24, 1911 And that death occurred on the date stated above at (time AM/PM): 8 AM THE CAUSE OF DEATH was as follows: Pulmonary Tuberculosis (Duration) Years: 11 Months: 4 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): E. C. McDonald Date: Aug 26, 1911 Address: Cloverport, 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: Cloverport, Ky DATE OF BURIAL: Aug 27, 1911 20. UNDERTAKER: M. Hamman & Son ADDRESS: Cloverport, Ky ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************