1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Union Star Inc Town: City: No. St. Ward: Registration District No.: Primary Registration District No: 5309 File No. 22680 Registered No: 11 2. FULL NAME: William B. Shellman PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: July 3, 1880 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 31 yrs 2 mos 2 ds 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farmer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Breckinridge Co. 10. NAME OF FATHER: John W. Shellman 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Latitia Keys 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Maydee Mitchell (Address) Mooleyville, Ky 15. Filed 9/27, 1911 REGISTAR: Lee Stewart MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Sept 26, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): Aug. 3, 1911 to Sept 26, 1911 That I last saw him/her alive on (date): Sept. 25, 1911 And that death occurred on the date stated above at (time AM/PM): 8 a.m. THE CAUSE OF DEATH was as follows: Typhoid fever (Duration) Years: Months: 1 Days: 23 Contributory: Abscess of the brain (Duration) Years: Months: Days: 12 Signed (M.D.): D. S. Sphire, M.D. Date: Sept 26, 1911 Address: Mooleyville, 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: Shellman grave yeard DATE OF BURIAL: 9/27, 1911 20. UNDERTAKER: W. J. Schopp ADDRESS: Stephensport, Ky