************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HARDINSBURG Inc Town: City: No. St. Ward: 2nd Registration District No.: 130 Primary Registration District No: 5302 File No. 30930 Registered No: 2. FULL NAME: WILSON, ROBERT M. PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: 1833 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 80 YRS 8. OCCUPATION (a.) Trade, profession or particular kind of work: RETIRED (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: J WILSON 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: SIMMONS 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) JOHN DOWNS (Address) LOCUST HILL 15. Filed DEC 11, 1913 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: OCT 27, 1913 [DELAY] 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): SEP 15, 1913 to OCT 27, 1913 And that death occurred on the date stated above at (time AM/PM): OCT 25, 1913 THE CAUSE OF DEATH was as follows: UREMIA (Duration) Years: Months: Days: 3 Contributory: (Duration) Years: Months: Days: Signed (M.D.): JOHN E. KINCHELOR Date: Address: HARDINSBURG 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: DOWNS CEM DATE OF BURIAL: OCT 28, 1913 20. UNDERTAKER: ROBT WEATHERFORD ADDRESS: HARNED ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************