************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HUDSON Inc Town: City: No. St. Ward: Registration District No.: 5316 Primary Registration District No: File No. 6242 Registered No: 2. FULL NAME: SMALLWOOD, LIZZIE M. PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: OCT 2, 1913 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 5 MO 1 DA 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KY 10. NAME OF FATHER: JESSE SMALLWOOD 11. BIRTHPLACE OF FATHER: KY 12. MAIDEN NAME OF MOTHER: HOMIE TANNIER 13. BIRTHPLACE OF MOTHER: KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) ELBRIDGE SMALLWOOD (Address) CONSTANTINE 15. Filed MAR 8, 1914 REGISTRAR: J. H. COMER MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: MARCH 6, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): MAR 4, 1914 That I last saw him/her alive on (date): MAR 5, 1914 And that death occurred on the date stated above at (time AM/PM): 6 AM THE CAUSE OF DEATH was as follows: ACUTE INDIGESTION (Duration) Years: Months: Days: 2 Contributory: PNEUMONIA (Duration) Years: Months: Days: 8 Signed (M.D.): S. J. HALL Date: MAR 7, 1914 Address: CONSTANTINE 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: SMALLWOOD CEMETERY DATE OF BURIAL: MAR 7, 1914 20. UNDERTAKER: R. T. HASKINSON ADDRESS: CONSTANTINE, KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************