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

Copyright.  All rights reserved.

http://www.usgwarchives.net/copyright.htm

http://www.usgwarchives.net/ky/kyfiles.html

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

1.    PLACE OF DEATH

County:  Breckenridge

Vot. Pol.:  McDaniels

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5318

Primary Registration District No:  

File No.  26165

Registered No:  

2.    FULL NAME:  Shellie Ree Pool

PERSONAL AND STATICAL PARTICULARS

3.    SEX:  female

4.    COLOR OR RACE:  white

5.    SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married

6.    DATE OF BIRTH:  July 5, 1888

7.    AGE  (yr. mo. da) (If less than 1 day, hours or min?):  25 years, 3         months, 25 days

8.    OCCUPATION (a.) Trade, profession or particular kind of work:  housewife

(b.)  General nature of industry business or establishment which employed:  

9.    BIRTHPLACE:  Breckenridge County, KY

10.   NAME OF FATHER: E. F. Mattingly 

11.   BIRTHPLACE OF FATHER:  Breckenridge Co., KY

12.   MAIDEN NAME OF MOTHER:  Nannie Leslie

13.   BIRTHPLACE OF MOTHER:  Breckenrige Co., KY

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  Ed F. Mattingly

(Address)  Westview, KY

15.   Filed  Nov. 1, 1913

REGISTAR:  M. M. Jarboe

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  October 30, 1913

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Oct 30 to Oct 30, 1913

That I last saw him/her alive on (date):  Oct 30, 1913

And that death occurred on the date stated above at (time AM/PM):  11.50 AM

THE CAUSE OF DEATH was as follows:  Accidentally burned to death

 

(Duration)   Years:            Months:            Days:  lived about 5 hours

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.): J. B. Lampton, MD 

Date:  Nov 1, 1913

Address:  McDaniels, 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:  Coyles Cemetery

DATE OF BURIAL:  Oct. 31, 1913

20.   UNDERTAKER:  Citizens

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

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