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1.	PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Hardinsburg, KY
Inc Town:  McQuady, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5301
File No.  31013
Registered No:  
2.	FULL NAME:  Ermin Gladis Burdette
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  Sept 6, 1913
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  2 mos 8 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Breckenrdige
10.	NAME OF FATHER:  Frank Burdette
11.	BIRTHPLACE OF FATHER:  Hancock County
12.	MAIDEN NAME OF MOTHER:  Bertha Smith
13.	BIRTHPLACE OF MOTHER:  Hancock County
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Frank Burdette
(Address)  McQuady Ky
15.	Filed  Dec 14, 1913
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Nov 13, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  11-12, 1913 to 11-13, 1913
That I last saw her alive on (date):  11-12, 1913
And that death occurred on the date stated above at (time AM/PM):  12 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:  11-14, 1913
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:  Hancock, Co
DATE OF BURIAL:  Nov 14, 1913
20.	UNDERTAKER:  E. F. Lyons
ADDRESS:  McQuady, Ky


ADDITIONAL COMMENTS/NOTES:




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