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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HUDSON
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5316
File No.  14878
Registered No:  
2.	FULL NAME:  TATE, WILLIAM
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  MAR 1, 1837
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  77 / 3 / 15
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  CRAVE TATE
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  ROBINSON
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  SAM WHITWORTH
(Address)  CONSTANTINE
15.	Filed  JUN 15, 1914
REGISTAR:  J.H. COMER
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JUN 15, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV 25, 1913 to JUN 14, 1914
That I last saw him/her alive on (date):  JUN 14, 1914
And that death occurred on the date stated above at (time AM/PM):  5 AM
THE CAUSE OF DEATH was as follows:  CHRONIC INTERSTITIAL NEPHRITIS - ARTEREOSCLEROSIS
(Duration)   Years:            Months:     6       Days:    20
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S.J. HALL
Date:  CONSTANTINE
Address:  
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:  McGUFFIN CEM
DATE OF BURIAL:  JUN 16, 1914
20.	UNDERTAKER:  TAYLOR & GRAY
ADDRESS:  CUSTER


ADDITIONAL COMMENTS/NOTES:




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