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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, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  131
Primary Registration District No:  
File No.  11894
Registered No:  63
2. FULL NAME:  Joseph N. Ray
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  July 5, 1860
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  51 yrs  9 mos  25 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hancock Co., Ky
10. NAME OF FATHER:  Henry C. Ray
11. BIRTHPLACE OF FATHER:  Indiana
12. MAIDEN NAME OF MOTHER:  Marget E. Giest
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  A. G. Ray
(Address)  Cloverport, Ky
15. Filed  May 30, 1912
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  May 29, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 9, 1912 to May 29, 1912
That I last saw him/her alive on (date):  May 29, 1912
And that death occurred on the date stated above at (time AM/PM):  10 p.m.
THE CAUSE OF DEATH was as follows:  Intestinal Tuberculosis

(Duration)   Years:   1         Months:   -         Days:  -
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. R. Lightfoot, M.D.
Date:  May 30, 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:  Hancock Co., Ky
DATE OF BURIAL:  May 30, 1912
20. UNDERTAKER:  M. Hamman & Sons
ADDRESS:  Cloverport, Ky


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Copyright.  All rights reserved.
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