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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BALL TOWN
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5321
Primary Registration District No:  21
File No.  599
Registered No:  2
2.	FULL NAME:  BROWN, NELLIE FRANCIS  [SPELLING OF FRANCES AS LISTED]
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  JAN 11, 1914
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  16 DAYS
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  BRECKINRIDGE COUNTY
10.	NAME OF FATHER:  MARION BROWN
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE COUNTY
12.	MAIDEN NAME OF MOTHER:  MAUDE VANER LAMPTON
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE COUNTY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  MARION BROWN
(Address)  McQUADY
15.	Filed  FEB 16, 1914
REGISTAR:  FRED FRANK
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JAN 27, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  ONE CALL, JAN 27, 1914
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  MALNUTRITION
(Duration)   Years:            Months:            Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A.L. KINCHELOE
Date:  FEB 2, 1914
Address:  McQUADY
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:  NOT LISTED
DATE OF BURIAL:  
20.	UNDERTAKER:  PETE SHERRAN
ADDRESS:  KIRK, KY


ADDITIONAL COMMENTS/NOTES:




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