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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  MOOLEYVILLE
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5310
Primary Registration District No:  
File No.  9521
Registered No:  18
2.	FULL NAME:  BROWN, MARTHA ALLEN
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  OCTOBER 12, 1881
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  32 YR 1 MO 1 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  GENERAL HOUSEWORK
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE CO., KY
10.	NAME OF FATHER:  ROBERT BROWN
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE CO., KY
12.	MAIDEN NAME OF MOTHER:  GERTRUDE BROWN
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO., KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  L. D. BROWN
(Address)  MOOLEYVILLE, KY
15.	Filed  APRIL 14, 1913
REGISTAR:  J. D. CUNNINGHAM
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APRIL 14, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  APRIL 7, 1911
That I last saw him/her alive on (date):  AUGUST 27, 1912
And that death occurred on the date stated above at (time AM/PM):  10 PM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS OF THE SKIN

(Duration)   Years:   2         Months:            Days:  7
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  D. S. SPIRE
Date:  APRIL 7, 1912
Address:  
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:  ST. TERESA'S
DATE OF BURIAL:  APRIL 15, 1913
20.	UNDERTAKER:  CHRIS BURCH
ADDRESS:  MOOLEYVILLE, KY


ADDITIONAL COMMENTS/NOTES:




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