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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  3
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  
File No.  27965
Registered No: 16 
2.	FULL NAME:  NEVITT, WILLIE H.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  NOV 19, 1847
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  17 / 0 / 0 
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  NEAR FRYMIER, KENTUCKY
10.	NAME OF FATHER:  GABE NEVITT
11.	BIRTHPLACE OF FATHER:  MEADE COUNTY
12.	MAIDEN NAME OF MOTHER:  EVA ROBERTS
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  G.E. B____
(Address)  FRYMIRE, KENTUCKY
15.	Filed  DEC 9, 1914
REGISTAR:  LEE ________  [FADED]
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 19, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEATH OCCURED BY GUNSHOT WOUND
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:  TOOK HIS LIFE BY HIMSELF ON _____ FORK NEAR A CLIFF WITH A GUN SHOT WOUND NEAR KNEE
(Duration)   Years:            Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.D. FRYMIRE
Date:  NOV 19, 1914
Address:  
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:  ST THERESA
DATE OF BURIAL:  NOV 20, 1914
20.	UNDERTAKER:  J.E. BALL
ADDRESS:  ____ILLE  [FADED]


ADDITIONAL COMMENTS/NOTES:  PART OF CAUSE OF DEATH EXTENDS BEYOND RIGHT MARGIN OF MICROFILM COPY - MAY BE "WITH A GUN SHOT WOUND NEAR NECK [sp]




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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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