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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.:  12
Inc Town:  Irvington, Ky
City:  Irvington, Ky
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5312
File No.  433
Registered No:  5312
2. FULL NAME:  Albert Everet Pumsay
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  baby
6. DATE OF BIRTH:  Aug. 5, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  6 mos  5 ds
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:  Jas. Ramsey
11. BIRTHPLACE OF FATHER:  Indiana
12. MAIDEN NAME OF MOTHER:  
13. BIRTHPLACE OF MOTHER:  
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Jas. Pamsay
(Address)  Irvington, Ky
15. Filed  Jan. 30, 1912
REGISTAR:  D. W. Henry
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  January 17, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 1, 1912 to Jan. 17, 1912
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  3 a.m.
THE CAUSE OF DEATH was as follows:  Bronchtis

(Duration)   Years:            Months:   1         Days:  
Contributory:  Malassisimulation

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S. P. Parks, M.D.
Date:  Jan. 18, 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:  Stevensport
DATE OF BURIAL:  Jan 18, 1912
20. UNDERTAKER:  
ADDRESS:  


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Copyright.  All rights reserved.
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