************************************************************************ 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.: 5307 Inc Town: City: CLOVERPORT No. St. Ward: 3rd Registration District No.: Primary Registration District No: File No. 30819 Registered No: 178 2. FULL NAME: MORRISON, SON PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: DEC 18, 1914 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): STILLBORN 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: CLOVERPORT 10. NAME OF FATHER: CLYDE GARFIELD MORRISON 11. BIRTHPLACE OF FATHER: PEAKINS, ILLINOIS 12. MAIDEN NAME OF MOTHER: CARRIE MAY GRAHAM 13. BIRTHPLACE OF MOTHER: CLOVERPORT 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) CLYDE GARFIELD MORRISON (Address) CLOVERPORT 15. Filed DEC 18, 1914 REGISTAR: J.C. NOLTE MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: DEC 18, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: STILLBORN (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): C.R. LIGHTFOOT Date: DEC 18, 1914 Address: CLOVERPORT 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 DATE OF BURIAL: DEC 18, 1914 20. UNDERTAKER: M. HAMMAN & SONS ADDRESS: CLOVERPORT ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************