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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: 5306
Inc Town: Cloverport
City:
No.
St.
Ward
Registration District No.: 131
Primary Registration District No: 5306
File No. 32805
Registered No: 21
1. FULL NAME: Dessie Pauline Elder
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: infant
5. DATE OF BIRTH: April 10, 1910
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?):1yr2mos1d
7. OCCUPATION (a.) Trade, profession or particular kind of work: none
(b.)  General nature of industry business or establishment which employed: none
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Joe C Elder
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Annie L Mattingly
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Joe Beavins
(Address) Cloverport, Ky
14. Filed June 20, 1911
REGISTAR: JC Nolte
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: June 20, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): June 19, 1911 to June 20, 1911
That I last saw him/her alive on (date): June 20, 1911
And that death occurred on the date stated above at (time AM/PM): 10 AM
THE CAUSE OF DEATH was as follows:
Acute Meningitis
(Duration)
Years:
Months:
Days: 36 hours
Contributory: Cholera Infantum in a strumoreas Diarhhsis
Duration: 36 hours
Signed (M.D.): F.L. Lightfoot
Date: June 20, 1911
Address: Cloverport, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Hardinsburg, Ky
DATE OF BURIAL: June 21, 1911
19. UNDERTAKER: M. Hamman & Son
ADDRESS: Cloverport, Ky

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Copyright.  All rights reserved.
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