************************************************************************ 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.: 12 Inc Town: IRVINGTON City: No. St. Ward: Registration District No.: 5312 Primary Registration District No: File No. 25216 Registered No: 5312 2. FULL NAME: NORTON, AILSIE J. BASHAM PERSONAL AND STATICAL PARTICULARS 3. SEX: OCT 8, 1834 4. COLOR OR RACE: FEMALE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: WHITE 6. DATE OF BIRTH: WIDOW 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 79 / 11 / 28 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: FRANK BASHAM 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: HARDIN 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) ROBERT NORTON (Address) LODIBURG 15. Filed REGISTAR: MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: OCT 6, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): OCT 2, 1914 tO OCT 6, 1914 That I last saw him/her alive on (date): OCT 6, 1914 And that death occurred on the date stated above at (time AM/PM): 9 PM THE CAUSE OF DEATH was as follows: PNEUMONIA (Duration) Years: Months: Days: 6 Contributory: (Duration) Years: Months: Days: Signed (M.D.): S.P. PARKS Date: OCT 7, 1914 Address: IRVINGTON 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: RAYMOND CEM DATE OF BURIAL: OCT 7, 1914 20. UNDERTAKER: G.T. MARSHALL & SONS ADDRESS: IRVINGTON 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 ************************************************************************