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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  
Inc Town:  STEPHENSPORT
City:  
No.  
St.  
Ward:  
Registration District No.:  5308
Primary Registration District No:  
File No.  6236
Registered No:  49
2.	FULL NAME:  BARBER, MARY H.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  DEC. 25, 1856
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  57 YR 1 MO 18 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWIFE
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  HANCOCK CO., KY
10.	NAME OF FATHER:  BARNEY BLANFORD
11.	BIRTHPLACE OF FATHER:  UNKNOWN
12.	MAIDEN NAME OF MOTHER:  JANE FURGESON
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO., KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  N. G. BARBER
(Address)  STEPHENSPORT, KY
15.	Filed  MARCH 13, 1914
REGISTRAR:  R. A. SHELLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MARCH 13, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MARCH 13, 1914
That I last saw him/her alive on (date):  MARCH 13, 1914
And that death occurred on the date stated above at (time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  ACUTE DILATION OF HEART COMPLICATING LA GRIPPE

(Duration)   Years:            Months:           Days:  
Contributory:  LA GRIPPE

(Duration)   Years:            Months:            Days:  21
Signed (M.D.):  B. H. PARRISH
Date:  MARCH 13, 1914
Address:  STEPHENSPORT, KY
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:  HITES RUN, KY
20.	UNDERTAKER:  C. A. TINIUS
ADDRESS:  STEPHENSPORT, KY


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Copyright.  All rights reserved.
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