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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. Pct:  BALLTOWN

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  

Primary Registration District No:  

File No.  17202

Registered No: 7

2.       FULL NAME:  SANDERS, HATTIE BELLE

PERSONAL AND STATISTICAL PARTICULARS

3.       SEX:     FEMALE

4.       COLOR OR RACE:  WHITE

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  

6.       DATE OF BIRTH: AUG 9, 1910

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?):  11 MONTHS

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

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

9.       BIRTHPLACE:  BRECKINRIDGE

10.   NAME OF FATHER:  ROBERT SANDERS

11.   BIRTHPLACE OF FATHER:  BRECKINRIDGE

12.   MAIDEN NAME OF MOTHER:  ANNIE SMITH

13.   BIRTHPLACE OF MOTHER:  HANCOCK COUNTY

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

(Informant)  

(Address)  

15.   Filed  AUG 5, 1911

REGISTAR:  FRED FRANK

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  JUL 11, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date):  JUL 25, 1911 to JUL 27, 1911

That I last saw him/her alive on (date):  JUL 26, 1911

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

THE CAUSE OF DEATH was as follows:  ENTERITIS

 

(Duration)   Years:            Months:            Days:  

Contributory:  GOOD SANITARY CONDITIONS

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  WILLIAM HOWARD

Date:  MATTINGLY, KY

Address:  

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:  

DATE OF BURIAL:  

20.   UNDERTAKER:  E.F. LYONS

ADDRESS:  MCQUADY, KY


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Copyright.  All rights reserved.
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