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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.: ROCKVALE 
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5320
Primary Registration District No:  
File No.  27973
Registered No:  18
2.	FULL NAME:  BOARD, NANCY JANE PIERCE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOWED
6.	DATE OF BIRTH:  JUL 9, 1845
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  69 / 4 / 14
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  FEILDON PIERCE  [GIVEN NAME IS SMEARED]
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER: DON'T KNOW 
13.	BIRTHPLACE OF MOTHER:  DON'T KNOW
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  HENRY BOARD
(Address)  c/o TOM BOARD, VANZANDT, KY
15.	Filed  NOV 25, 1914
REGISTAR:  J.D. MCDONOUGH
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 23, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV 20, 1914 to NOV 20, 1914
That I last saw him/her alive on (date):  NOV 20, 1914
And that death occurred on the date stated above at (time AM/PM):  2 PM
THE CAUSE OF DEATH was as follows:  PNEUMONIA LOBAR
(Duration)   Years:            Months:            Days:    10
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  P.E. DEMPSTER
Date:  NOV 24, 1914
Address:  GLEN DEAN
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:  MACEDONIA
DATE OF BURIAL:  NOV 25, 1914
20.	UNDERTAKER:  DATA OVERWRITTEN - HARD TO READ
ADDRESS:  DATA OVERWRITTEN - HARD TO READ


ADDITIONAL COMMENTS/NOTES:




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