************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  138
Primary Registration District No:  5301
File No.  25771
Registered No:  
2.	FULL NAME:  SERMERSHEIM, ANDREW WILLIAM
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  CAUCASIAN
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  DEC 6, 1879
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  34 / 9 / 24
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  MACHINIST
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  CINCINNATTI, OHIO
10.	NAME OF FATHER:  MARTIN SERMERSHEIM
11.	BIRTHPLACE OF FATHER:  GERMANY
12.	MAIDEN NAME OF MOTHER:  MARY HURST
13.	BIRTHPLACE OF MOTHER:  GERMANY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MRS. ANDREW SHERMERSHEIM
(Address)  SOMERSET, KY
15.	Filed  OCT 3, 1913
REGISTAR:  W.B. LEMMON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  SEP 30, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  SEP 26, 1913 to SEP 30, 1913
That I last saw him/her alive on (date):  SEP 30, 1913
And that death occurred on the date stated above at (time AM/PM):  4PM
THE CAUSE OF DEATH was as follows:  HEMMORRHAGE OF LUNGS
(Duration)   Years:            Months:            Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A.L. KINCHLOE
Date:  OCT 7, 1913  [DELAYED DEATH CERTIFICATE]
Address:  MCQUADY, 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:  SOMERSET, KY
DATE OF BURIAL:  OCT 3, 1913
20.	UNDERTAKER:  J.T. HOBERN
ADDRESS:  HARDINSBURG, KY


ADDITIONAL COMMENTS/NOTES:




************************************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************