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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  1
Registration District No.:  130
Primary Registration District No:  5301
File No.  17175
Registered No:  37
2. FULL NAME:  Sarah Deliah Nash
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Nov. 16, 1878
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  32 yrs  7 mos  16 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Wife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  United States
10. NAME OF FATHER:  James Richard Phelps
11. BIRTHPLACE OF FATHER:  United States
12. MAIDEN NAME OF MOTHER:  Louisiana Johnson
13. BIRTHPLACE OF MOTHER:  United States
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Willie Lee Phelps
(Address)  Glen Dean, Ky
15. Filed  July 3, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  July 2, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  July 1, 1911 to July 2, 1911
That I last saw him/her alive on (date):  July 2, 1911
And that death occurred on the date stated above at (time AM/PM):  9 p.m.
THE CAUSE OF DEATH was as follows:  Acute Gastritis

(Duration)   Years:            Months:            Days:  4
Contributory:  Metorrhagia and Dysentery

(Duration)   Years:            Months:   2         Days:  2
Signed (M.D.):  W. H. Lucas, M.D.
Date:  July 3, 1911
Address:  McQuady, 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:  Charles Robertson’s
DATE OF BURIAL:  July 3, 1911
20. UNDERTAKER:  E. F. Lyons
ADDRESS:  McQuady, Ky.

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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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