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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  ROCKVALE
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5320
File No. 33680 
Registered No:  
2.	FULL NAME: DORA LISLE COX  
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE: WHITE  
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  1900
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): AT HOME  
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  DAVIESS CO, KY
10.	NAME OF FATHER:  JOHN COX
11.	BIRTHPLACE OF FATHER:  DK
12.	MAIDEN NAME OF MOTHER:  WILSON
13.	BIRTHPLACE OF MOTHER:  DK
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  CRIT BURTON
(Address)  ROCKVALE KY
15.	Filed  11/12/1913
REGISTAR: JD McDONOUGH 
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 9, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date): NOV 4, 1913 TO NOV 9, 1913 
That I last saw her alive on (date):  NOV 7, 1913
And that death occurred on the date stated above at (time AM/PM): 9AM 
THE CAUSE OF DEATH was as follows:  
TRAUMATIC PERITONITIS
(Duration)   Years:            Months:            Days:  
Contributory:  INJURY

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. DE WEESE
Date:  NOV 9, 1913
Address:  FORDSVILLE, 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: LONE STAR GRAVE YARD  
DATE OF BURIAL: NOV 10, 1913 
20.	UNDERTAKER: C.E. FORD CO 
ADDRESS:  FORDSVILLE, KY


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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