3. Sex:
Male |
4. Color
or Race
White |
5.
Single, Married, Widowed or Divorced:
Widower |
5a. If married, widowed
or divorced:
Husband of: Cynthia Nelson |
| |
| 6. DATE OF
BIRTH: November 1861 |
| 7. AGE: 59
yrs. |
| 8.
OCCUPATION OF DECEASED: Farmer |
| 9.
BIRTHPLACE: Bracken Co., Ky. |
PARENTS:
10. NAME OF FATHER: Andrew Nelson |
| 11.
BIRTHPLACE OF FATHER: Ky. |
| 12. MAIDEN
NAME OF MOTHER: Mahala Garber |
| 13.
BIRTHPLACE OF MOTHER: Tenn. |
14.
Informant: Charles Nelson
(Address) 1735 Elin St |
| 15. Filed
Jan. 4, 1920 E. W___ E___ (Registrar) |
|
| 16. DATE OF DEATH:
Jan. 1, 1920 |
17. I HEREBY CERTIFY
That I attended deceased from: (blank)
The CAUSE OF DEATH was as follows:
CORONER Viewed remains.
No inquest necessary
Probably: Cerebral Hemorrhage
CONTRIBUTORY: Arterio sclerosis
Was there an autopsy? No
What test confirmed diagnosis? History
(Signed) Arthur C. Ba__, M.D. Coroner per E. J. B.
1/3, 1920 (Address) __blank___ |
19. PLACE OF BURIAL,
CREMATION OR REMOVAL: New Richmond, O.
DATE OF BURIAL: Jany. 4, 1920 |
20. UNDERTAKER,
License No. 66a
E. P. White & Son, New Richmond, O. |
|
