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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.:  5315
Primary Registration District No:  
File No.  27667
Registered No:  18
2.  FULL NAME:  Nettie Wright
PERSONAL AND STATICAL PARTICULARS
3.  SEX:  Female
4.  COLOR OR RACE:  White
5.  SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.  DATE OF BIRTH:  November 7, 1892
7.  AGE  (yr. mo. da) (If less than 1 day, hours or min?):  18 yrs. 11 mos. 20 days
8.  OCCUPATION (a.) Trade, profession or particular kind of work:  At home
(b.)  General nature of industry business or establishment which employed:  
9.  BIRTHPLACE:  Breckinridge Co, KY
10.  NAME OF FATHER:  Henry A. Wright
11.  BIRTHPLACE OF FATHER:  Hardin County, KY
12.  MAIDEN NAME OF MOTHER:  Lucretia Powell
13.  BIRTHPLACE OF MOTHER:  Breckinridge Co, KY
14.  THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  William A. Allen
(Address)  Custer, KY
15.  Filed  Oct 30, 1911
REGISTAR:  R. O. Penick
MEDICAL CERTIFICATE OF DEATH
16.  DATE OF DEATH:  November 28, 1911
17.  I HEREBY CERTIFY, That I attended deceased from (date):  July 15, 1911 to oct 21, 1911
That I last saw her alive on (date):  Oct 21, 1911
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  Tuberculosis of lungs and bowels

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. W. Meador
Date:  Oct 30, 1911
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 Cemetery
DATE OF BURIAL:  Oct 30, 1911
20.  UNDERTAKER:  R. O. Penick
ADDRESS:  Custer, Ky


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