1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  12
Inc Town:  Irvington
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  30575
Registered No:  17
2. FULL NAME:  Wash Thompson
PERSONAL AND STATICAL PARTICULARS
3. SEX:  M
4. COLOR OR RACE:  W
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widower
6. DATE OF BIRTH:  Nov. 10, 1824
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  87 yrs  1 mos  3 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farming
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hardin Co.
10. NAME OF FATHER:  Jim Thompson
11. BIRTHPLACE OF FATHER:  
12. MAIDEN NAME OF MOTHER:  
13. BIRTHPLACE OF MOTHER:  
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Geo Thompson
(Address)  Irvington, Ky
15. Filed  Dec 14, 1911
REGISTAR:  D. W. Henry
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Dec. 13, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Nov. 28, 1911 to Dec. 12, 1911
That I last saw him/her alive on (date):  Dec. 12, 1911
And that death occurred on the date stated above at (time AM/PM):  11 a.m.
THE CAUSE OF DEATH was as follows:  Paralysis

(Duration)   Years:            Months:            Days:  16
Contributory:  Old age

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. A. Baxter, M.D.
Date:  Dec. 13, 1911
Address:  Guston, Ky
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:  Battletown, Ky
DATE OF BURIAL:  Dec. 14, 1911
20. UNDERTAKER:  G. T. Marshall & Son
ADDRESS:  Irvington, Ky
************************************************************************
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

************************************************************************