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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.:  UNION STAR
Inc Town:  
City:  
No.  
St.  
Ward:
Registration District No.:  5309
Primary Registration District No:  
File No.  3506
Registered No:  2
2.	FULL NAME:  WEST, BRANTON
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  1846
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  68 YR
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  FARMING
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KY
10.	NAME OF FATHER:  GEORGE WEST
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  WOOLWEIN
13.	BIRTHPLACE OF MOTHER:  UNKNOWN
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JAMES ST. CLAIR
(Address)  WEBSTER, KY
15.	Filed  2/5/1914
REGISTRAR:  LEE STEWARD
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  FEB 3, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  JAN. 27, 1914
That I last saw him/her alive on (date):  FEB 2, 1914
And that death occurred on the date stated above at (time AM/PM):  5:45 PM
THE CAUSE OF DEATH was as follows:  SMALLPOX

(Duration)   Years:            Months:           Days:  11
Contributory:  [UNREADABLE]

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. M. KINCHELOE
Date:  
Address:  HARDINSBURG, 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:  RAYMOND, KY
DATE OF BURIAL:  FEB 4, 1914
20.	UNDERTAKER:  J. T. HOBBS
ADDRESS:  HARDINSBURG, KY

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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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