************************************************************************
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.:  Custer
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  
File No.  5637
Registered No:  6
2. FULL NAME:  Morris, Erenest
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  Jan. 20, 1894
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  19 y 2 mo 0 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge County, KY
10. NAME OF FATHER:  Thomas Morris
11. BIRTHPLACE OF FATHER:  Breckinridge County, KY
12. MAIDEN NAME OF MOTHER:  Rhoda Bell Basham
13. BIRTHPLACE OF MOTHER:  Breckinridge County, KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Jesse Brunes
(Address)  Custer, KY
15. Filed  March 21, 1911
REGISTAR:  R. O. Penick
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 20, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 14, 1911
That I last saw him/her alive on (date):  Jan. 14, 1911
And that death occurred on the date stated above at (time AM/PM):  10 AM
THE CAUSE OF DEATH was as follows:  Pulmonary Tuberculosis

(Duration)   Years:            Months:   6       Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. B. Witt
Date:  March 20, 1911
Address:  Big Spring, 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:  Basham Graveyard
DATE OF BURIAL:  March 21, 1911
20. UNDERTAKER:  Chris Gentry
ADDRESS:  Kingswood, KY

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