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

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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

1. PLACE OF DEATH
County: Breckinridge Co	
Vot. Pol.: Glendeane
Inc Town: near Glendeane, Ky
City:
No.
St.
Ward
Registration District No.: 132
Primary Registration District No: 5319
File No. 11263
Registered No:
1. FULL NAME: Still Born Powell
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married (it actually has this)
5. DATE OF BIRTH: April 7, 1911
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?):
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co, Ky
9. NAME OF FATHER: Railey Powell
10. BIRTHPLACE OF FATHER: Grayson Co, Ky
11. MAIDEN NAME OF MOTHER: Sarah Burnetts
12. BIRTHPLACE OF MOTHER: Grayson Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Dunk Powell
(Address) Glendeane, Ky
14. Filed Apr 7, 1911
REGISTAR: E.L. Robertson
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: April 7, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): April 7, 1911 to same April 7, 1911
That I last saw him/her alive on (date): never
And that death occurred on the date stated above at (time AM/PM):
THE CAUSE OF DEATH was as follows:

(Duration)
Years:
Months:
Days:
Contributory: Still Born
Signed (M.D.): P.E. Dempster
Date: April 7, 1911
Address: Glendeane, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Powell Burying Gr
DATE OF BURIAL: April 7, 1911
19. UNDERTAKER: Tom Jones
ADDRESS: Glen Dean

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