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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Mook
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5317
File No. 189
Registered No: 16
1. FULL NAME: Nannie Cavitt
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: widow
5. DATE OF BIRTH: 11/4/1835
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 70yrs1mo9ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: housework
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: James K   son
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: unknown
12. BIRTHPLACE OF MOTHER:
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) John Whitworth
(Address) Mook, Ky
14. Filed 
REGISTAR:
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: 12/13/1912
16. I HEREBY CERTIFY, That I attended deceased from (date): 12-12, 1912 to 12-13, 1912
That I last saw him/her alive on (date): 12-12, 1912
And that death occurred on the date stated above at (time AM/PM): 3PM
THE CAUSE OF DEATH was as follows:
Meningeal hemorrhage
(Duration)
Years:
Months:
Days: 3
Contributory: old age
Signed (M.D.): S.J.Hall
Date: 12-13, 1912
Address: Constantine
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
DATE OF BURIAL: Dec 14, 1912
19. UNDERTAKER:
ADDRESS: Mook, Ky

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Copyright.  All rights reserved.
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