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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.:  Beweleyville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5313
Primary Registration District No:  
File No.  14427
Registered No:  4
2. FULL NAME:  William Arthur
PERSONAL AND STATICAL PARTICULARS
3. SEX:  male
4. COLOR OR RACE:  black
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6. DATE OF BIRTH:  February 17, 1914
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  20 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge County, Ky
10. NAME OF FATHER:  illegitimate
11. BIRTHPLACE OF FATHER:  
12. MAIDEN NAME OF MOTHER:  Fannie Hunter
13. BIRTHPLACE OF MOTHER:  Breckinridge County, Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Dr. P. W. Foote
(Address)  Irvington, Ky RFD 1
15. Filed  6/20, 1914
REGISTAR:  John Compton
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 10, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  March 10 to March 10, 1914
That I last saw him/her alive on (date):  March 10, 1914
And that death occurred on the date stated above at (time AM/PM):  2 AM
THE CAUSE OF DEATH was as follows:  Croup
 
(Duration)   Years:            Months:            Days:   4 hours
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Dr. P. W. Foote
Date:  march 11, 1914
Address:  Irvington, 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:  Farm of Sam Hunter
DATE OF BURIAL:  March 11, 1914
20. UNDERTAKER:  None  P. W. Foote
ADDRESS:  Irvington, Ky
 

ADDITIONAL COMMENTS/NOTES:
 
 


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