Commonwealth of Kentucky State board of Health BUREAU OF VITAL STATISTICS File No. 222627 Registered No. 3611 1. County Jefferson Primary Registration District 2275 City Louisville 2. Full Name James A. (it really looks like an X, but it is swiped) Vertrees And I do know it is A. it's on his head stone, and in the census records, and also in the funeral book of Grandma's 3. SEX M 4. Color White 5. Single, married d widowed or divorced Widower 6. Date of BIRTH April 5th, 1855 (this is wrong it's the 15th) 7. Age 73 yrs 5 months 4 da 8. Occupation of DECEASED Carpenter 9. Birthplace Hardin Co., KY 10. Name of Father Thomas Vertrees 11. Birthplace KY 12. Maiden Name of Mother Elizabeth Keiper really (Kiper) 13. Birthplace of Mother KY 14. Informant J. T. Vertrees 2216 Date ST. 15. Filed Sep 10 1928 16. Date of Death Sept 9, 1928 17. I hereby Certify that I attended deceased from Aug 30, 1928 To Sept, 9, 1928, that I last saw him alive Sept 8, 1928 and the death occurred on the date stated above at 10.45 A. M. The cause of death Apoplexy Contributory (secondary) Odeud Kwnge? 18. Where was Disease Contracted did an operation precede death NO Date of ____Was there an autopsy No What Test confirmed Diagnosis? (signed C. J. Forsee Per. MD 19. 9/10/1928 address Francis Bld 20. Place of Burial or Removal Big Clifty Date of Burial 9-11-1928 21. Undertaker MC David Brd address City