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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.  22927
Registered No: 87 
2.	FULL NAME:  SUTTON, ALVIA
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  MAR 27, 1914
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  0 / 5 / 9
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE
10.	NAME OF FATHER:  ILLEGITIMATE
11.	BIRTHPLACE OF FATHER:  DON'T KNOW
12.	MAIDEN NAME OF MOTHER:  HATTIE SUTTON
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  ELBA BUTLER 
(Address)  CUSTER
15.	Filed  SEP 5, 1914
REGISTAR:  J.S. MITCHAM
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: SEP 5, 1914 
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAR 27, 1914 to 
That I last saw him/her alive on (date):  MAR 27, 1914
And that death occurred on the date stated above at (time AM/PM):  4 AM
THE CAUSE OF DEATH was as follows:  INANITION  [first two letters hard to cipher]
(Duration)   Years:            Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.W. MEADOR
Date:  SEP 5, 1914
Address:  CUSTER
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:  BASHAM BLS
DATE OF BURIAL:  SEP 5, 1914
20.	UNDERTAKER:  J.L. GRAY
ADDRESS:  CUSTER


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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