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

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

1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  ROCKVALE
Inc Town:  
City:  
No.  
St.  
Ward:
Registration District No.: 5320 
Primary Registration District No:  
File No.  27974
Registered No:  19
2.	FULL NAME:  WELLS, JAMES L.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  SEPT 19, 1857
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  57 YR 2 MO 6 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE CO., KY
10.	NAME OF FATHER:  JOHN W. WELLS
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  SALLIE BOWMAN
13.	BIRTHPLACE OF MOTHER:  KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  NOLIE ASHLEY
(Address)  GLEN DEAN, KY
15.	Filed  NOV 27, 1914
REGISTRAR:  J. D. MCDONOUGH
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 25, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  AUG. 4, 1914
That I last saw him/her alive on (date):  NOV. 18, 1914
And that death occurred on the date stated above at (time AM/PM):  4 PM
THE CAUSE OF DEATH was as follows:  PULMONARY TUBERCULOSIS

(Duration)   Years:            Months:     7      Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  P. E. DEMPSTER
Date:  NOV. 24, 1914
Address:  GLEN DEAN, 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:  BOB TOWN CHURCH
DATE OF BURIAL:  NOV. 26, 1914
20.	UNDERTAKER:  G. E. FUQUA
ADDRESS:  FORDSVILLE, KY




************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************