************************************************************************ 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.: Rock Vale Inc Town: City: No. St. Ward Registration District No.: Primary Registration District No: File No. 19033 Registered No: 5320 2. FULL NAME: Estell Willson PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: Feb 8, 1898 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 24 yrs 6 mos 28 da 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farmer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Butler Co KY 10. NAME OF FATHER: Martin Willson 11. BIRTHPLACE OF FATHER: Butler Co KY 12. MAIDEN NAME OF MOTHER: Martha Bryant 13. BIRTHPLACE OF MOTHER: Butler Co KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Ace P Nash (Address) Rockvale KY 15. Filed Aug 6, 1912 REGISTAR: J D McDonogh MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Aug 5, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): June 4, 1912 to Aug 5, 1912 That I last saw him/her alive on (date): Aug 5, 1912 And that death occurred on the date stated above at (time AM/PM): 10 AM THE CAUSE OF DEATH was as follows: Nepritis (Duration) Years: Months: 2 Days: 15 Signed (M.D.): R T Dempster Date: Aug 6, 1912 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 DATE OF BURIAL: 20. UNDERTAKER: ADDRESS: ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************