30628 Registration district 5392 or 4 Place of death Calloway Co Inc. Town Hazel KY James Phillips Male White Date of birth 9/2211864 age 47 yrs 3 months 7 days Farmer Birthplace Calloway County Name of father Westly Phillips Birth place Calloway Co maiden name of mother Sarah Ward birthplace of mother Calloway The above is true to the best of my knowledge J. J. Erin Hazel KY Date of death 12 29 191 I hereby certify that I attended the deceased from 12/27/1911 to 12/29/1911 and that death occurred at 7 P. M. duration 3 days Pnmemonia Contributary Dropsy Eward b. Hauston M. D. 13/30/1911 Hazel KY Place of burial Pleasant Grove Date of burial 12/30/1911 undertaker W. D. Kelly Hazel KY