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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 Co.
Vot. Pol.:  Bewley Ville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  9236
Registered No:  3
2. FULL NAME:  Sally Priest
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  May 29, 1845
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  66 yrs  10 mos  14 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeper
(b.)  General nature of industry business or establishment which employed:  House work
9. BIRTHPLACE:  Rosetta, Ky  Breckinridge Co.
10. NAME OF FATHER:  `Henderson Board
11. BIRTHPLACE OF FATHER:  Rosetta Ky. Breckinridge Co.
12. MAIDEN NAME OF MOTHER:  Don’t Know
13. BIRTHPLACE OF MOTHER:  
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  P. C. Dent
(Address)  Irvington, Ky.  R. F. D. 2
15. Filed  4/20, 1912
REGISTAR:  John Compton
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Apr. 14, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 4, 1912 to Apr. 14, 1912
That I last saw him/her alive on (date):  Apr. 14, 1912
And that death occurred on the date stated above at (time AM/PM):  8 p.m.
THE CAUSE OF DEATH was as follows:  General Peritonitis

(Duration)   Years:            Months:   2         Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. Sandbach, M.D.
Date:  Apr 15, 1912
Address:  Garfield, 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:  
DATE OF BURIAL:  
20. UNDERTAKER:  
ADDRESS:  


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Copyright.  All rights reserved.
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