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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.  12330
Registered No: 5312 
2.	FULL NAME:  OSBORNE, RAY
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  CHILD
6.	DATE OF BIRTH:  JAN 11, 1913
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 / 4 / 3
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  COLORADO
10.	NAME OF FATHER:  ALLEN G. OSBORNE
11.	BIRTHPLACE OF FATHER:  INDIANA
12.	MAIDEN NAME OF MOTHER:  LUCY ROBBINS
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C.W. ROBBINS
(Address)  IRVINGTON
15.	Filed  MAR 15, 1914
REGISTAR:  D.W. HENRY
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 14, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAY 2, 1914 to MAY 14, 1914
That I last saw him/her alive on (date):  MAY 13, 1914
And that death occurred on the date stated above at (time AM/PM):  4 AM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS
(Duration)   Years:            Months:     2       Days:    
Contributory:  ENTERITIS
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S.P. PARKS
Date:  MAR 14, 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:  FREEDOM
DATE OF BURIAL:  MAY 15, 1914
20.	UNDERTAKER:  G.T. MARSHALL
ADDRESS:  IRVINGTON


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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