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

Copyright.  All rights reserved.

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

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

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

1.    PLACE OF DEATH

County:  Breckenridge Co

Vot. Pol.:  5305

Inc Town:  Cloverport

City:  

No.  

St.  

Ward:  1st

Registration District No.:  131

Primary Registration District No:  

File No.  31413

Registered No:  133

2.    FULL NAME:  Suida Pool

PERSONAL AND STATICAL PARTICULARS

3.    SEX:  female

4.    COLOR OR RACE:  colored

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

6.    DATE OF BIRTH:  Dec 13, 1835

7.    AGE  (yr. mo. da) (If less than 1 day, hours or min?):  78 years, 9 days

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

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

9.    BIRTHPLACE:  Kentucky

10.   NAME OF FATHER:  Don't Know

11.   BIRTHPLACE OF FATHER:  Don't Know

12.   MAIDEN NAME OF MOTHER:  Don't Know

13.   BIRTHPLACE OF MOTHER:  Don't Know

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

(Informant)  Joe C. Bradford

(Address)  Cloverport, Ky

15.   Filed  Dec 22, 1913

REGISTAR:  J. C. Nolte

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Dec 22, 1913

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Dec 10 to Dec 13, 1913

That I last saw him/her alive on (date):  Dec 15, 1913

And that death occurred on the date stated above at (time AM/PM):  7:30 AM

THE CAUSE OF DEATH was as follows:  Senility

 

(Duration)   Years:            Months:            Days:  

Contributory:  Old Age

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  F. L. Lightfoot

Date:  Dec 22, 1913

Address:  Cloverport, 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:  Cloverport, Ky

DATE OF BURIAL:  Dec 23, 1913

20.   UNDERTAKER:  M. Hamman & Son

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

 

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