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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  STEPHENSPORT
Inc Town:  STEPHENSPORT
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5308
File No.  6237
Registered No:  
2.	FULL NAME:  MORRIS, ARAD  [NEXT LETTER SMEARED, BUT CONFIRMED ON SON'S DC]
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JUN 3, 1861
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  57 / 9 / 11
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  LABORER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER:  JOHN MORRIS
11.	BIRTHPLACE OF FATHER:  DON'T KNOW
12.	MAIDEN NAME OF MOTHER:  DON'T KNOW
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MRS IDA MORRIS
(Address)  STEPHENSPORT
15.	Filed  MAR 21, 1914
REGISTAR:  R.A. SKILLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAR 14, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAR 10, 1914 to MAR 14, 1914
That I last saw him/her alive on (date):  MAR 14, 1914
And that death occurred on the date stated above at (time AM/PM):  1 PM
THE CAUSE OF DEATH was as follows:  ACTIVE CONGESTION OF LUNG
(Duration)   Years:            Months:            Days:    5
Contributory:  NEPHRITIS
(Duration)   Years:     2       Months:            Days:  
Signed (M.D.):  GEORGE E. SHIVELEY
Date:  
Address:  STEPHENSPORT
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:  MERRILL CEM / STEPHENSPORT
DATE OF BURIAL:  MAR 15, 1914
20.	UNDERTAKER:  T.A. FINIUS
ADDRESS:  STEPHENSPORT


ADDITIONAL COMMENTS/NOTES:




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