************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: MOOK Inc Town: City: No. St. Ward: Registration District No.: 5317 Primary Registration District No: File No. 2965 Registered No: 1. FULL NAME: ROBINSON, ETHER LEE PERSONAL AND STATICAL PARTICULARS 2. SEX: FEMALE 3. COLOR OR RACE: CAUCASION 4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 5. DATE OF BIRTH: INFANT - STILLBORN 6. AGE (yr. mo. da) (If less than 1 day, hours or min?): 7. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 8. BIRTHPLACE: KENTUCKY 9. NAME OF FATHER: HERBY ROBINSON 10. BIRTHPLACE OF FATHER: MOOK 11. MAIDEN NAME OF MOTHER: ADA SMILEY 12. BIRTHPLACE OF MOTHER: MOOK 13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) HERBY ROBINSON (Address) MOOK 14. Filed FEB 18, 1911 REGISTAR: V.G. GOODMAN MEDICAL CERTIFICATE OF DEATH 15. DATE OF DEATH: FEB 18, 1911 16. I HEREBY CERTIFY, That I attended deceased from (date): STILLBORN That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: STILLBORN (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.C. TUCKER Date: FEB 18, 1911 Address: MCDANIEL, 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: FAIRVIEW DATE OF BURIAL: FEB 18, 1911 19. UNDERTAKER: G.F. GALLOWAY ADDRESS: MOOK ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************