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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  UNION STAR
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  
File No.  9452
Registered No:  
2. FULL NAME:  CHAPPELL, MARY J.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  DEC. 31, 1870
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  43 YR 3 MO 24 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWIFE
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  BRECKINRIDGE CO., KY
10. NAME OF FATHER:  LEWIS CORT
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  HARRIET MYERS
13. BIRTHPLACE OF MOTHER:  INDIANA
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C. A. CHAPPELL
(Address)  UNION STAR,  KY
15. Filed  APR . 26, 1914
REGISTRAR:  UNION STAR, KY
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  APR. 25, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  MARCH 11, 1914
That I last saw him/her alive on (date):  APR. 25, 1914
And that death occurred on the date stated above at (time AM/PM):  8 PM
THE CAUSE OF DEATH was as follows:  PELVIC ABSCESS

(Duration)   Years:            Months:     1      Days:  14
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  WILLIAM L. MILNER  
Date:  APR. 27, 1914
Address:  UNION STAR, KY
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:  UNION STAR, KY
DATE OF BURIAL:  APR. 27, 1914
20. UNDERTAKER:  D. S. RICHARDSON
ADDRESS:  UNION STAR, KY