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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.:
Inc Town:
City:
No.
St.
Ward   3
Registration District No.:  136 ??
Primary Registration District No:  5303
File No.    27661
Registered No:  68
2. FULL NAME:  Elder, J. Genivive
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white American
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  Jun2 7, 1892
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  19 yrs.  6 mos  15 ds.
8. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
9. BIRTHPLACE:   Breckinridge County, KY
10. NAME OF FATHER:  Thomas N. Elder
11. BIRTHPLACE OF FATHER:  Breckinridge County, KY
12. MAIDEN NAME OF MOTHER:  Dessie Elder
13. BIRTHPLACE OF MOTHER:  Breckinridge County, KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Tom Elder
(Address)  Hardinsburg, KY
15. Filed  Nov. 23, 1911
REGISTAR:  W. B. Lennore
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  November 22, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  August, 1911 to November 22, 1911
That I last saw him/her alive on (date):  November 10, 1911
And that death occurred on the date stated above at (time AM/PM):  5 p.m.
THE CAUSE OF DEATH was as follows:
Pulmonary Tuberculosis
(Duration)
Years:
Months:  9 mos. 
Days:
Signed (M.D.):  E. S. Lex
Date:  Nov. 23, 1911
Address:  Hardinsburg, 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  St. Romualds Cem.  
DATE OF BURIAL:  Nov. 23, 1911
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg, KY

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Copyright.  All rights reserved.
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