1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Cloverport
Inc Town:
City:
No.
St.
Ward
Registration District No.: 131
Primary Registration District No: 5306
File No. 9228
Registered No: 57
1. FULL NAME: Joseph Elder
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: April 19, 1912
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 12min
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Benedict Elder
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Matilda Jane Bivens
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Benedict Elder
(Address) Cloverport
14. Filed April 19, 1912
REGISTAR: JC Nolte
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: April 18, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date):
That I last saw him/her alive on (date):
And that death occurred on the date stated above at (time AM/PM):
THE CAUSE OF DEATH was as follows:
Premature birth
(Duration)
Years:
Months:
Days:
Signed (M.D.): Jno E Kincheloe
Date: April 18, 1912
Address: Hardinsburg, 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: St Romuald Cemetery
DATE OF BURIAL: April 18, 1912
19. UNDERTAKER: illegible
ADDRESS: <Hardinsburg>