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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.: Custer

Inc Town:

City:

No.

St.

Ward

Registration District No.:

Primary Registration District No:

File No. 436

Registered No: 21

2.       FULL NAME: Jesse L Wright

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Male

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Single

6.       DATE OF BIRTH: August 9, 1888

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 23 yrs 6 mos 12 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

10.   NAME OF FATHER: Henry A Wright

11.   BIRTHPLACE OF FATHER: Breckinridge Co KY

12.   MAIDEN NAME OF MOTHER: Lucretia Powell

13.   BIRTHPLACE OF MOTHER: Breckinridge Co

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Alfred Allen

(Address) Custer KY

15.   Filed Jan 29, 1912

REGISTAR: R O Pennick

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: January 28, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date): Feb 14, 1909 to Jan 24, 1912

That I last saw him/her alive on (date): Jan 24, 1912

And that death occurred on the date stated above at (time AM/PM): 4 PM

THE CAUSE OF DEATH was as follows: Tuberculosis of Lungs and Throat

 

(Duration)

Years: 

Months:

Days:

Signed (M.D.): J W Meador

Date: Jan 24, 1912

Address: Custer 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 Gray Cemetary

DATE OF BURIAL: Jan 29, 1912

20.   UNDERTAKER: R O Pennick

ADDRESS: Custer KY


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Copyright.  All rights reserved.
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