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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  5306
Inc Town:  Cloverport, Ky
City:  
No.  
St.  
Ward:  2nd
Registration District No.:  131
Primary Registration District No:  
File No.  12265
Registered No:  106
2.	FULL NAME:  Mrs. Florence Bland
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  White (sic)
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  Dec. 6, 1856
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  56 yrs  5 mos  4 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  House keeper
(b.)  General nature of industry business or establishment which employed:  General Housework
9.	BIRTHPLACE:  Kentucky
10.	NAME OF FATHER:  Joshua Haycraft
11.	BIRTHPLACE OF FATHER:  Kentucky
12.	MAIDEN NAME OF MOTHER:  Matilda Cravens
13.	BIRTHPLACE OF MOTHER:  Virginia
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  John H. Bland
(Address)  Cloverport, Ky
15.	Filed  May 11, 1913
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  May 10, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Jan, 1911 to death
That I last saw him/her alive on (date):  Feb 1913
And that death occurred on the date stated above at (time AM/PM):  10 p.m.
THE CAUSE OF DEATH was as follows:  ______ of bones of lower limbs (one amputated many years ago) resulting abscesses and edema of lungs of late.

(Duration)   Years:  19          Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  B. T. Rafferty, M.D.
Date:  May 11, 1913
Address: Cloverport, 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:  Kirk, Ky
DATE OF BURIAL:  May 11, 1913
20.	UNDERTAKER:  M. Hamman Sons
ADDRESS:  Cloverport, Ky


ADDITIONAL COMMENTS/NOTES:




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