Bourbon County, Kentucky death certificate of Eliza Warner Clark

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Date: Sun, 26 Jan 2003
Darrell Warner
From: http://www.genrecords.net/emailregistry/vols/00001.html#0000008
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BOURBON COUNTY, KENTUCKY DEATH CERTIFICATE
OF ELIZA (WARNER) CLARK

1. Place of death
County: Bourbon
Inc. town: North Middleton
Registration district number: 93
Primary registration districr number: 4178
File number: 27682
Registered number: 80
2. Full name: Eliza Clark
3. Sex: female
4. Color or race: white
5. Single, married, widowed or divorced: widowed
5a. If married, widowed or divorced name of husband: John A. Clark
6. Date of birth: 1860
7. Age: 72
8, 9, 10 and 11. Occupation: housekeeper
12: Birthplace: Kentucky
13. Name of father: Jacob Warner
14. Birthplace of father: Kentucky
15. Maiden name of mother: Elizabeth Shultz
16. Birthplace of mother: Kentucky
17. Informant: Mattie Clark RR2 Paris, Kentucky
18. Burial: Old Fields Cemetery December 24, 1932
19. Undertaker: Shrout, Piper and Shrout, Owingsville, Kentucky
20. Filed: 1-12-1933
21. Date of death: December 22, 1932
22. Cause of death: myocarditis
23. Was death accident, suicide of homicide: no
24. Signed: G. A. Cook