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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward:  2
Registration District No.:  5302
Primary Registration District No:  
File No.  27954
Registered No:  
2. FULL NAME:  CODY, SALLIE ANN
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  DEC. 5, 1846
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  68 YR 11 MO
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPING
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  ALADLEN PULLIAM
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  JUDITH SCOTT
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  DR. J. M. CODY
(Address)  HARDINSBURG, KY
15. Filed  NOV. 6, 1914
REGISTRAR:  W. B. LENNON
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  NOV. 3, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  NOV. 3, 1914
That I last saw him/her alive on (date):  NOV. 26, 1914
And that death occurred on the date stated above at (time AM/PM):  9 AM
THE CAUSE OF DEATH was as follows:  CHRONIC INTESTINAL NEPHRITIS

(Duration)   Years:  8          Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. M. KINCHELOE
Date:  
Address:  HARDINSBURG, 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:  SCOTT CEMETERY
DATE OF BURIAL:  NOV. 6, 1914
20. UNDERTAKER:  B. F. BEARD & CO.
ADDRESS:  HARDINSBURG, KY