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m. 16 Aug 1921
Facts and Events
BATH COUNTY, KENTUCKY DEATH CERTIFICATE 1. Place of death a. County: Bath b. Voter precinct: Shurborn c. Inc. Town: nothing listed d. City: nothing listed e. Registration district number: nothing listed f. Primary registration district number: 53 g. File number: 24367 h. Registered number: nothing listed 2. Full name: No Name (Should be Annie) 3. Sex: female 4. Color or race: white 5. Single, married, widowed or divorced: single 5a. Infant of Roy Henderson 6. Date of birth: October 25, 1927 7. Age nothing listed 8. Occupation: nothing listed 9. Birthplace: nothing listed (should be Bath County, Kentucky) 10. Name of father: James Bailey 11. Birthplace of father: Kentucky 12. Maiden name of mother: Annie Henderson 13. Birthplace of mother: Kentucky 14. Informant: Herburt Doves of Owingsville 15. Filed: nothing listed Registrar: nothing listed 16. Date of death: December 4, 1929 17. I hereby certify, That I attended deceased from October 25, 1927 to November 7, 1927, that I last saw her alive on November 7, 1927, and that death occurred on the date stated above at 2:00 PM. The cause of death was as follows: broncho-pneumonia. Contributory causes: malnutrition 18a. Where was disease contracted: nothing listed 18b. Signed: H. S. Gilmer Date: November 1927 19a. Place of burial: Bethel Cemetery 19b. Date of burial:November 8, 1927 20. Undertaker: E. L. Barns of Owingsville, Kentucky References
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