************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HARDINSBURG Inc Town: City: No. St. Ward: 2 Registration District No.: 130 Primary Registration District No: 5302 File No. 6228 Registered No: 2. FULL NAME: TATE, MARVIN DYER [?] PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: OCT 28, 1913 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 0 / 4 / 28 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: TAYLOR TATE 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: MARTHA E. McGARY 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) TAYLOR TATE (Address) HARDINSBURG 15. Filed MAR 5, 1914 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: MAR 26, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): MAR 21, 1914 to MAR 26, 1914 That I last saw him/her alive on (date): NEVER SAW And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: (Duration) Years: Months: Days: 10 Contributory: (Duration) Years: Months: Days: Signed (M.D.): JNO E. KINCHELOR Date: MAR 26, 1914 Address: HARDINSBURG 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: TATE CEMETERY DATE OF BURIAL: MAR 27, 1914 20. UNDERTAKER: B.F. BEARD & CO ADDRESS: HARDINSBURG 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 ************************************************************************