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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Rockvall
Inc Town:
City:
No.
St.
Ward
Registration District No.: 132
Primary Registration District No: 5320
File No. 11261
Registered No:
1. FULL NAME: Nora Bryant
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: Oct 1894
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 16yrs 6mos
7. OCCUPATION (a.) Trade, profession or particular kind of work: housekeeper
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Grayson Co, Ky
9. NAME OF FATHER: C.C. Nottingham
10. BIRTHPLACE OF FATHER: Grayson Co, Ky
11. MAIDEN NAME OF MOTHER: Ella Cummings
12. BIRTHPLACE OF MOTHER: Grayson Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Mark Nottingham
(Address) Falls of Rough, Ky
14. Filed April 11, 1911
REGISTAR: E.L. Robertson
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: April 10, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): April 9, 1911 to April 10, 1911
That I last saw him/her alive on (date): April 10, 1911
And that death occurred on the date stated above at (time AM/PM): 9:00 PM
THE CAUSE OF DEATH was as follows:
Eclampsia
(Duration) 40 hours
Years:
Months:
Days:
Signed (M.D.): J.B. Lampton
Date: 4/11/1911
Address: McDaniels, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Lone Star Cemetery, Falls of Rough, Ky
DATE OF BURIAL: 4/11/1911
19. UNDERTAKER: Green Bros
ADDRESS: Falls of Rough

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Copyright.  All rights reserved.
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