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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.:  Hardinsburg
Inc Town:  Hardinsburg
City:  
No.  
St.  
Ward:  3
Registration District No.:  130
Primary Registration District No:  5303
File No.  6172
Registered No:  82
2. FULL NAME:  WM. Carl Pyles
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  Colored
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  Feb. 18, 1887
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  25 yrs  14 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Clerk
(b.)  General nature of industry business or establishment which employed:  Father
9. BIRTHPLACE:  Breckinridge Co.
10. NAME OF FATHER:  Wm. Morris Pyles
11. BIRTHPLACE OF FATHER:  Hardinsburg, Ky
12. MAIDEN NAME OF MOTHER:  Jennie Hawkins
13. BIRTHPLACE OF MOTHER:  Hardinsburg, Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Wm. Morris Pyle
(Address)  Hardinsburg, Ky
15. Filed  Mar 4, 1912
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 3, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  July 24, 1911 to March 3, 1912
That I last saw him/her alive on (date):  March 2, 1912
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  Tuberculosis

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E. A. Lex, M.D.
Date:   3/4, 1912
Address:  Hardinsburg, 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:  Colored Cemetery
DATE OF BURIAL:  Mar. 5, 1912
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg, Ky


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Copyright.  All rights reserved.
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