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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hudson, Ky
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5316
File No. 14276
Registered No: 11
1. FULL NAME: Martha Ramsey
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: 3-4-1886
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?):
7. OCCUPATION (a.) Trade, profession or particular kind of work: housework
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: E.L. Jeffries
10. BIRTHPLACE OF FATHER: Lile Town, Ky
11. MAIDEN NAME OF MOTHER: unknown
12. BIRTHPLACE OF MOTHER: Lile Town, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Wm. Allgood
(Address) Madrid, Ky
14. Filed 6/10/1911
REGISTAR: JH Comer
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: 6/2/1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Feb 1, 1911 to May 26, 1911
That I last saw him/her alive on (date): May 26, 1911
And that death occurred on the date stated above at (time AM/PM): 6:09 AM
THE CAUSE OF DEATH was as follows:
Tuberculosis Pulmonallis
(Duration)
Years:
Months: 4
Days: 16
Signed (M.D.): S.J. Hall
Date: 6-2-1911
Address: Constantine, 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: Eastern Star Church
DATE OF BURIAL: 6-3-1911
19. UNDERTAKER: Rhodes & Storm
ADDRESS: McDaniels, Ky

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Copyright.  All rights reserved.
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