************************************************************************
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.:  Cloverport, Ky
Inc Town:  5306
City:  
No.  
St.  
Ward:  
Registration District No.:  131
Primary Registration District No:  5306
File No.  6234
Registered No:  146
2. FULL NAME:  Judith Pate
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  March 10, 1914
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  [blank]
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Infant
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., Ky
10. NAME OF FATHER:  Henry L. Pate
11. BIRTHPLACE OF FATHER:  Breckinridge Co., Ky
12. MAIDEN NAME OF MOTHER:  Nettie Morton
13. BIRTHPLACE OF MOTHER:  Breckinridge Co., Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Henry L. Pate
(Address)  hardinsburg, Ky
15. Filed  March 10, 1914
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 10, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  Premature Birth
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:  Premature Birth
 
(Duration)   Years:            Months:            Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  John E. Kincheloe
Date:  March 10, 1914
Address:  Hardinsburg, 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:  Patterson, Breckinridge Co., Ky
DATE OF BURIAL:  March 10, 1914
20. UNDERTAKER:  Alvin J. Pate
ADDRESS:  Cloverport, Ky
 

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