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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  
Inc Town:  GLEN DEAN
City:  
No.  
St.  
Ward:
Registration District No.: 5319 
Primary Registration District No:  19
File No.  25220
Registered No:  
2.	FULL NAME:  WELLS, ARTIE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JAN 17, 1850
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  53 YR 10 MO 8 DA (SIC)
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  GRAYSON CO., KY
10.	NAME OF FATHER:  PERRY BOZARTH
11.	BIRTHPLACE OF FATHER:  GRAYSON CO., KY
12.	MAIDEN NAME OF MOTHER:  (UNKNOWN)
13.	BIRTHPLACE OF MOTHER:  GRAYSON CO., KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  CAL BLAIN
(Address)  ASKEW, KY
15.	Filed  OCT 18, 1914
REGISTRAR:  MRS. MOLLY DEMPSTER
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 8 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  SEPT 8, 1914
That I last saw him/her alive on (date):  SEPT. 30, 1914
And that death occurred on the date stated above at (time AM/PM):  4 AM
THE CAUSE OF DEATH was as follows:  TYPHOID FEVER

(Duration)   Years:            Months:     1      Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.) : R. G. DEMPSTER 
Date:  GLEN DEAN
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:  
DATE OF BURIAL:  OCT 9, 1914
20.	UNDERTAKER:  H. WILSON CO.
ADDRESS:  GLEN DEAN


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Copyright.  All rights reserved.
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