************************************************************************
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.:  
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5301
File No.  
Registered No:  
2.	FULL NAME:  OWEN, MISSIE DEHAVEN
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  BLACK
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JAN 13, 1888
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  25 / 10 / 4
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  GEORGE DEHAVEN
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  PATSY SCOTT
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  HICKS OWEN
(Address)  McQUADY
15.	Filed  APR 18, 1914
REGISTAR:  W.B. LEMMON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APR 17, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEC 1, 1913 to APR 12, 1914
That I last saw him/her alive on (date):  APR 12, 1914
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  CARCINOMA OF UTERUS
(Duration)   Years:     1       Months:     6       Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): P.E. DEMPSTER 
Date:  APR 18, 1914
Address:  GLEN DEAN
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:  McQUADY
DATE OF BURIAL:  APR 18, 1914
20.	UNDERTAKER:  
ADDRESS:  


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

************************************************************************