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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  2067
File No.  9040
Registered No:  
2.	FULL NAME:  BRYANT, OCTAVA MATTINGLY
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  MAY 6, 1881
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  33 / 11 / 23
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  HOUSEWIFE
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  LYNN MATTINGLY
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MARY CARBID
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  
(Address)  
15.	Filed  APR 30, 1915
REGISTAR:  MRS SUE JOLLY
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  APR 29, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEC 1914 to APR 29, 1915
That I last saw him/her alive on (date):  APR 29, 1915
And that death occurred on the date stated above at (time AM/PM):  1 PM
THE CAUSE OF DEATH was as follows:  PULMONARY TUBERCULOSIS
(Duration)   Years:            Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): E.A. LEX 
Date:  APR 29, 1915
Address:  IRVINGTON
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:  MT. MERCER
DATE OF BURIAL:  APR 30, 1915 G.T. MARSHAUSEN
20.	UNDERTAKER:  G.T. MARSHAUSEN
ADDRESS:  IRVINGTON


ADDITIONAL COMMENTS/NOTES:




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