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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  
Inc Town:  Glen Dean, Ky
City:  
No.  
St.  
Ward:  
Registration District No.:  5319
Primary Registration District No:  19
File No.  19922
Registered No:  8
2.	FULL NAME:  Mary E. Dean
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6.	DATE OF BIRTH:  Aug. 12, 1829
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  84 yrs  11 mos  21 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Housekeeper
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Muhlenburg Co., Ky
10.	NAME OF FATHER:  J. W. I. Godman
11.	BIRTHPLACE OF FATHER:  Virginia
12.	MAIDEN NAME OF MOTHER:  Elizabeth Nicole
13.	BIRTHPLACE OF MOTHER:  Muhlenburg Co., Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C. W. Dean
(Address)  Glen Dean, Ky
15.	Filed  July 10, 1914
REGISTAR:  Mrs. Molly Dempster
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  July 10, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  June 20, 1914 to July 8, 1914
That I last saw him/her alive on (date):  July 8, 1914
And that death occurred on the date stated above at (time AM/PM):  12 a.m.
THE CAUSE OF DEATH was as follows:  Old Age

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R. T. Dempster, M.D.
Date:  
Address:  Glen Dean, 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:  Dean Cemetery
DATE OF BURIAL:  July 10, 1914
20.	UNDERTAKER:  J. T. Hoban
ADDRESS:  


ADDITIONAL COMMENTS/NOTES:




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