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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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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Rockvale
Inc Town:  
City:  Glendeane, Ky
No.  
St.  
Ward:  
Registration District No.:  132
Primary Registration District No: 5320 
File No.  30089
Registered No:  
2. FULL NAME:  Bertha Lee Phelps
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  Aug. 4, 1909
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  2 yrs  2 mos  11 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge County Ky
10. NAME OF FATHER:  Lee Phelps
11. BIRTHPLACE OF FATHER:  Butler Co. Ky
12. MAIDEN NAME OF MOTHER:  Ida Florense Wilson
13. BIRTHPLACE OF MOTHER:  Butler County, Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  M. John J. Askin
(Address)  Glendeane
15. Filed  Oct 25, 1911
REGISTAR:  E. L. Robertson
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Oct. 20, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Oct. 13, 1911 to Oct. 20, 1911
That I last saw him/her alive on (date):  Oct 19, 1911
And that death occurred on the date stated above at (time AM/PM):  7 a.m.
THE CAUSE OF DEATH was as follows:  A cholera infantum

(Duration)   Years:            Months:            Days:  7
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  M. O. Robertson  M.D.
Date:  Oct. 20, 1911
Address:  Glendeane, 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:  Robertson Bur. Cem.
DATE OF BURIAL:  Oct. 21, 1911
20. UNDERTAKER:  Nat Ball
ADDRESS:  McQuady


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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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************************************************