************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: Breckenridge Vot. Pol.: Hardinsburg Inc Town: City: No. St. Ward: 3 Registration District No.: 130 Primary Registration District No: 5303 File No. 6358 Registered No: 148 2. FULL NAME: Hiram Mathew Shresbury PERSONAL AND STATICAL PARTICULARS 3. SEX: male 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single 6. DATE OF BIRTH: July 25, 1912 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 7 months, 15 days 8. OCCUPATION (a.) Trade, profession or particular kind of work: Infant (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Kentucky 10. NAME OF FATHER: Paul Shrewsbury 11. BIRTHPLACE OF FATHER: Kentucky 12. MAIDEN NAME OF MOTHER: Maggie Allen Wither 13. BIRTHPLACE OF MOTHER: Kentucky 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) John Dunn (Address) Hardinsburg, Ky 15. Filed March 13, 1913 REGISTAR: W. B. Lennon MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: March 12, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): March 1 to March 12, 1913 That I last saw him/her alive on (date): March 10, 1913 And that death occurred on the date stated above at (time AM/PM): 6 AM THE CAUSE OF DEATH was as follows: Labor Pneumonia (Duration) Years: Months: Days: 12 Contributory: (Duration) Years: Months: Days: Signed (M.D.): Jno. E. Kincheloe Date: March 12, 1913 Address: Hardinsburg, 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: De Jarretts Cemetery DATE OF BURIAL: March 13, 1913 20. UNDERTAKER: Jno T. Hoben 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 ************************************************************************