************************************************************************ 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.: McDaniels Inc Town: City: No. St. Ward Registration District No.: Primary Registration District No: File No. 19032 Registered No: 2. FULL NAME: Anderson Wilson PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married 6. DATE OF BIRTH: April 1, 1884 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 28 yrs 4 mos 18 da 8. OCCUPATION (a.) Trade, profession or particular kind of work: Farm Laborer (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Butler Co KY 10. NAME OF FATHER: Jackson Wilson 11. BIRTHPLACE OF FATHER: Butler Co KY 12. MAIDEN NAME OF MOTHER: Turner 13. BIRTHPLACE OF MOTHER: Butler Co KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Wiley Smith (Address) Glen Dean KY 15. Filed Aug 18, 1912 REGISTAR: M M Jarboe MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Aug 19, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): Aug 18, 1912 That I last saw him/her alive on (date): Aug 18, 1912 And that death occurred on the date stated above at (time AM/PM): 8:30 AM THE CAUSE OF DEATH was as follows: Accidental pistol shot wound in lower part of abdomen (Duration) About 13 1/2 hrs Years: Months: Days: Signed (M.D.): J B Lampton Date: Aug 19, 1912 Address: McDaniels KY 18. LENG TH 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 McDaniels Cemetery DATE OF BURIAL: Aug 19, 1912 20. UNDERTAKER: Rhodes Stompton ADDRESS: McDaniels KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************