************************************************************************
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.: 12

Inc Town: Irvington

City: Irvington

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 23326

Registered No: 5312

2.       FULL NAME: Ross, Infant

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Female

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: 

6.       DATE OF BIRTH: Feb 7, 1912

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): a few minutes 1/2 hour

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

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

9.       BIRTHPLACE: Irvington KY

10.   NAME OF FATHER: Ernest Ross

11.   BIRTHPLACE OF FATHER: Irvington KY

12.   MAIDEN NAME OF MOTHER: Beulah Claycomb

13.   BIRTHPLACE OF MOTHER: Irvington KY

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

(Informant) Ernest Ross

(Address) Irvington KY

15.   Filed Feb 17, 1912

REGISTAR: D W Hesseg

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: Feb 7, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Feb 7, 1912 to Feb 7, 1912

That I last saw him/her alive on (date): Feb 7, 1912

And that death occurred on the date stated above at (time AM/PM): 11 AM

THE CAUSE OF DEATH was as follows: Premature Birth

 

(Duration)  A few minutes

Years:

Months:

Days:

Signed (M.D.): S P Parks

Date: Feb 8, 1912

Address: Irvington 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 Bethel KY

DATE OF BURIAL: Feb 8, 1912

20.   UNDERTAKER: G T Marshall & Son

ADDRESS: Irvington KY


************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************