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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.: MOOLEYVILLE 
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No: 5310 
File No. 581 ABOVE 16
Registered No: 5310  
2.	FULL NAME: MARION BALLOW 
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE: WHITE 
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED: WIDOWED  
6.	DATE OF BIRTH: MAY 21, 1861 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 52YRS 9MOS 21DS 
8.	OCCUPATION (a.) Trade, profession or particular kind of work: FARMER 
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE: KENTUCKY 
10.	NAME OF FATHER:  JOHN BALLOW
11.	BIRTHPLACE OF FATHER: KENTUCKY 
12.	MAIDEN NAME OF MOTHER: CHARLOTTE SAPP 
13.	BIRTHPLACE OF MOTHER:  MARION CO
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) JIM BENNETT 
(Address) <    > KY
15.	Filed JAN 22, 1913  
REGISTAR:  LEE STEWART
	  BY R.A. SHELLMAN	
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: JAN 21, 1913  
17.	I HEREBY CERTIFY, That I attended deceased from (date): DEC 28, 1912 TO  
JAN 21, 1913
That I last saw him/her alive on (date): JAN 21, 1913 
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  
CHRONIC BRIGHTS DISEASE
(Duration)   Years:            Months: ABOUT 18         Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.): D.S. SPHIRE 
Date: JAN 21, 1913 
Address: MOOLEYVILLE 
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:  
DATE OF BURIAL:  
20.	UNDERTAKER: W.J. SCHOPP 
ADDRESS: STEPHENSPORT, KY 


ADDITIONAL COMMENTS/NOTES:




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