1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hudson, Ky
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5316
Primary Registration District No:  
File No.  8823
Registered No:  6
2. FULL NAME:  Still Borned Sharp
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6. DATE OF BIRTH:  April 20, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  Still Borned
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hudson, Ky
10. NAME OF FATHER:  Robt. Sharp
11. BIRTHPLACE OF FATHER:  Constantine
12. MAIDEN NAME OF MOTHER:  Eliza West
13. BIRTHPLACE OF MOTHER:  Constantine
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Family
(Address)  Hudson, Ky
15. Filed  4/25, 1911
REGISTAR:  J. H. Comer
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  April 20, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  Still Borned

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S. J. Hall, M.D.
Date:  4-20-1911
Address:  Constantine, 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:  Crumes Burial Ground
DATE OF BURIAL:  4, 21, 1911
20. UNDERTAKER:  R. Sharp	
ADDRESS:  Hudson, Ky
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