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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  MOOLEYVILLE
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5310
Primary Registration District No:  
File No.  21296
Registered No:  5310
2.	FULL NAME:  CUNNINGHAM, LOUISE J. SIMMS
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  RECORDED "x"
6.	DATE OF BIRTH:  JUN 23, 1844
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  71 / 2 / 12
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  RANDOLPH SIMMS
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  JULIA BEAVEN
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JULIA O'BRYAN
(Address)  
15.	Filed  SEP 5, 1915
REGISTAR:  J.D. CUNNINGHAM / MRS. S.R. O'BRYAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  SEP 5, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  AUG 8, 1915 to SEP 5, 1915
That I last saw him/her alive on (date):  SEP 5, 1915
And that death occurred on the date stated above at (time AM/PM):  8 AM
THE CAUSE OF DEATH was as follows:  INTESTINAL OBSTRUCTION
(Duration)   Years:            Months:     1       Days:    
Contributory:  CARDIAC IRREGULARITY
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  F.S. CLARK
Date:  SEP 5, 1915
Address:  MOOLEYVILLE
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:  ST. THERESAS
DATE OF BURIAL:  SEP 6, 1915
20.	UNDERTAKER:  J.E. BALL
ADDRESS:  ANDYVILLE


ADDITIONAL COMMENTS/NOTES:




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