************************************************************************ 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 ************************************************************************ 1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Mook Inc Town: City: No. St. Ward Registration District No.: Primary Registration District No: File No. 6189 Registered No: 13 2. FULL NAME: Tom Robinson PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: Sept 12, 1861 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 50 yrs 6 mos 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farmer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KY 10. NAME OF FATHER: Green Berry Robinson 11. BIRTHPLACE OF FATHER: KY 12. MAIDEN NAME OF MOTHER: 13. BIRTHPLACE OF MOTHER: Ann Wilson 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Hurbert Oarman (Address) Mook KY 15. Filed Mar 11, 1912 REGISTAR: V G Goodman MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: March 11, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): Mar 1, 1912 to Mar 10, 1912 That I last saw him/her alive on (date): March 10, 1912 And that death occurred on the date stated above at (time AM/PM): 5:50 AM THE CAUSE OF DEATH was as follows: Labor Pneumonia (Duration) Years: Months: Days: 10 da Signed (M.D.):J E Matthews Date: March 11, 1912 Address: Westview 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 Fairview DATE OF BURIAL: March 11, 1912 20. UNDERTAKER: Barnie Wilson ADDRESS: Mook KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************