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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 KY

City:

No.

St.

Ward 1

Registration District No.: 130

Primary Registration District No: 5301

File No. 9225

Registered No: 92

2.       FULL NAME: Ezikial Rhodes

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married

6.       DATE OF BIRTH: Jan 19, 1852

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 60 yr 3 mos 11da

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  (unreadable)

(b.)  General nature of industry business or establishment which employed:

9.       BIRTHPLACE: Kentucky

10.   NAME OF FATHER: Thomas Rhodes

11.   BIRTHPLACE OF FATHER: Kentucky

12.   MAIDEN NAME OF MOTHER: Emeline Henning

13.   BIRTHPLACE OF MOTHER: Kentucky

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Jno Hoben

(Address) Hardinsburg KY

15.   Filed Apr 30, 1912

REGISTAR: W B Lennon

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: April 30, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Jan 1910 to April 30, 1912

That I last saw him/her alive on (date): Apr 30, 1912

And that death occurred on the date stated above at (time AM/PM): 12 M

THE CAUSE OF DEATH was as follows: Chronic abscess of Lungs

 

(Duration)

Years: 2

Months: 4

Days: 0 

Signed (M.D.): Jno E Kincheloe

Date: Apr 30, 1912

Address: Hardinsburg

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 St Romualds Cem

DATE OF BURIAL: May 1, 1912

20.   UNDERTAKER: Jno T Hoben

ADDRESS: Hardinsburg




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Copyright.  All rights reserved.
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