************************************************************************ 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.: Glen Dean #7 Inc Town: City: No. St. Ward: Registration District No.: 5319 Primary Registration District No: File No. 594 Registered No: 2. FULL NAME: Dunk Powell PERSONAL AND STATICAL PARTICULARS 3. SEX: male 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married 6. DATE OF BIRTH: September 26, 1873 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 39 years, 3 months, 24 days 8. OCCUPATION (a.) Trade, profession or particular kind of work: farmer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: Marion Powell 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Bettie Ashley 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Jas. Powell (Address) Glen Dean 15. Filed Jan 21, 1913 REGISTAR: Mrs. M. O. Robertson MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Jan 20, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): Jan 20, 1913 And that death occurred on the date stated above at (time AM/PM): ? PM THE CAUSE OF DEATH was as follows: Accidental Fall From a Horse (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): P. E. Dempster Date: Jan 21, 1913 Address: Glen Dean, 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: Powell Cemetery DATE OF BURIAL: Jan 22, 1913 20. UNDERTAKER: W. Owen & Co. ADDRESS: Glen Dean, 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 ************************************************************************