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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CLOVERPORT
Inc Town:  CLOVERPORT
City:  
No.  
St.  
Ward:  
Registration District No.:  131
Primary Registration District No:  3065
File No.  21289
Registered No: 217 
2.	FULL NAME:  ARNOLD, JENNIE DEAN
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6.	DATE OF BIRTH: SEP 2, 1852 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  63 / 0 / 14
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWORK
(b.)  General nature of industry business or establishment which employed:  AT HOME
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  JOSEPH DEAN
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MARIAH FORKNER
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  ROBERT ARNOLD
(Address)  HARDINSBURG
15.	Filed  SEP 16, 1915
REGISTAR:  J.C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  SEP 16, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  JUL 15, 1915 to . . . 
That I last saw him/her alive on (date):  SEP 14, 1915
And that death occurred on the date stated above at (time AM/PM):  1:30 AM
THE CAUSE OF DEATH was as follows:  CANCER OF LIVER
(Duration)   Years:            Months:    3        Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): JOHN E. KINCHELOR 
Date:  SEP 16, 1915
Address:  HARDINSBURG
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19.	PLACE OF BURIAL OR REMOVAL:  CLOVERPORT
DATE OF BURIAL:  SEP 16, 1915
20.	UNDERTAKER:  M. HAMMAN & SONS
ADDRESS:  CLOVERPORT


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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