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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.: Moolyville

Inc Town:

City:

No. 10

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 93323

Registered No: 5310

2.       FULL NAME: Abner Greenberry Roberts

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

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

6.       DATE OF BIRTH: Jan 5, 1852

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 60 yrs 1 mos 16 da

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

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

9.       BIRTHPLACE: Concordia Meade Co KY

10.   NAME OF FATHER: Greenberry Roberts

11.   BIRTHPLACE OF FATHER: Do not know

12.   MAIDEN NAME OF MOTHER: Do not know

13.   BIRTHPLACE OF MOTHER: Do not know

14.   THE ABOVE IS TRUE TO THE BEST OF M Y KNOWLEDGE

(Informant) J G Bradis

(Address) Chenault KY

15.   Filed Feb 22, 1912

REGISTAR: J D Cunningham per Jennie Cunningham

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: Feb 21, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Feb 14, 1912 to Feb 21, 1912

That I last saw him/her alive on (date): Feb 20, 1912

And that death occurred on the date stated above at (time AM/PM): 3 AM

THE CAUSE OF DEATH was as follows: Labor Pneumonia

 

(Duration) 

Years:

Months:

Days: 13 da

Signed (M.D.): D S Sphire

Date: Feb 21, 1912

Address: Moolyville

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 Gethsemane

DATE OF BURIAL: Feb 22, 1912

20.   UNDERTAKER: E B Frymire

ADDRESS: Chenault KY





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Copyright.  All rights reserved.
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