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1.    PLACE OF DEATH

County:  Breckinridge

Vot. Pol.:  Custer

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5315

Primary Registration District No:  

File No.  29820

Registered No:  39

2.    FULL NAME:  Lizzie Skaggs

PERSONAL AND STATICAL PARTICULARS

3.    SEX:  female

4.    COLOR OR RACE:  white

5.    SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widow

6.    DATE OF BIRTH:  June 30, 1834

7.    AGE  (yr. mo. da) (If less than 1 day, hours or min?): 78 yr, 5 mo, 21 days

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

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

9.    BIRTHPLACE:  Garfield, Breckinridge County, KY

10.   NAME OF FATHER:  Abe Bruner

11.   BIRTHPLACE OF FATHER:  Garfield, Breckinridge County, KY

12.   MAIDEN NAME OF MOTHER:  Mrs. Penick

13.   BIRTHPLACE OF MOTHER:  Virginia

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

(Informant)  J M Webb

(Address)  Garfield, KY

15.   Filed  Dec. 25, 1912

REGISTAR:  J T Whitman

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  Dec. 21, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Dec 19, 1912 to Dec 21, 1912

That I last saw him/her alive on (date):  Dec 20, 1912

And that death occurred on the date stated above at (time AM/PM): 1 am 

THE CAUSE OF DEATH was as follows:  Apoplexy

 

(Duration)   Years:            Months:            Days:  1

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  J. A. Sandbach

Date:  Dec. 21, 1912

Address:  Garfield

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:  [blank]

DATE OF BURIAL:  Dec. 22, 1912

20.   UNDERTAKER:  D.B. Richardson

ADDRESS:  Garfield, KY

 

 

ADDITIONAL COMMENTS/NOTES: Breckinridge County Cemeteries, Volume 1, page 410 has Elizabeth Skaggs, w/o James buried Bruner Cemetery #5, 1 1/2 miles off Highway 60 on Garfield Woodrow Road.


 

 

 

 

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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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