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1.	PLACE OF DEATH
County: BRECKINRIDGE 
Vot. Pol.: IRVINGTON 
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:  
Registration District No.: 5312 
Primary Registration District No:  
File No. 31425 
Registered No: 5312 
2.	FULL NAME:  WILLIAM T. CORNWALL
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE: WHITE 
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH: JULY 5, 1835 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 78YRS 19DS 
8.	OCCUPATION (a.) Trade, profession or particular kind of work: FARMER 
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE: INDIANA 
10.	NAME OF FATHER: HARRISON T. CORNWALL 
11.	BIRTHPLACE OF FATHER: VIRGINIA 
12.	MAIDEN NAME OF MOTHER: NANCY CORNWALL 
13.	BIRTHPLACE OF MOTHER: VIRGINIA 
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) MARY CORNWALL 
(Address) IRVINGTON, KY 
15.	Filed  DEC 24, 1913
REGISTAR: D.W. HENRY
	SALLIE BEAUCHAMP 
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: DEC 24, 1913 
17.	I HEREBY CERTIFY, That I attended deceased from (date): DEC 5, 1913 TO DEC 24, 1913 
That I last saw him alive on (date): DEC 24, 1913  
And that death occurred on the date stated above at (time AM/PM):  8 PM
THE CAUSE OF DEATH was as follows:  
LA GRIPPE
(Duration)   Years:            Months:            Days: 16 
Contributory: <URA   >

(Duration)   Years:            Months:            Days: 8 
Signed (M.D.): P.H. NEVITT 
Date: DEC 24, 1913
Address: IRVINGTON, 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:  MT. CARMEL CEM
DATE OF BURIAL:  
20.	UNDERTAKER: G.T. MARSHALL & SON 
ADDRESS: IRVINGTON, KY 


ADDITIONAL COMMENTS/NOTES:




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