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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.:  5307
Inc Town:  Cloverport
City:  
No.  
St.  
Ward:  3
Registration District No.:  131
Primary Registration District No:  
File No.  9230
Registered No:  58
2. FULL NAME:  Wm. Preston
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  July 16, 1859
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  52 yrs  9 mos  8 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Retired Merchant
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Wm. Preston
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Mary Schrodder
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Amanda Schrad
(Address)  Patesville, Ky
15. Filed  Apr. 25, 1912
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  April 24, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feby 24, 1912 to April 24, 1912
That I last saw him/her alive on (date):  April 20, 1912
And that death occurred on the date stated above at (time AM/PM):  11 a.m.
THE CAUSE OF DEATH was as follows:  Acute Uraemia

(Duration)   Years:            Months:  3          Days:  24
Contributory:  Strumous Diathesis

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  F. L. Lightfoor, M.D.
Date:  April 25, 1912
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:  April 25, 1912
20. UNDERTAKER:  M. Hamman & Sons
ADDRESS:  Cloverport, Ky


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Copyright.  All rights reserved.
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