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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, KY 
City:  
No.  
St.  
Ward:  2ND
Registration District No.:   131
Primary Registration District No:  5306
File No. 31414
Registered No: 134  
2. FULL NAME:  VIRGINIA ELDER
PERSONAL AND STATICAL PARTICULARS
3. SEX:   FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  MAY 15, 1899
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  14 YR. 7 MO. 12 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  SCHOOL GIRL  
(b.)  General nature of industry business or establishment which employed:   
9. BIRTHPLACE: KENTUCKY
10. NAME OF FATHER:  JOE. C. ELDER
11. BIRTHPLACE OF FATHER:  KENTUCKY
12. MAIDEN NAME OF MOTHER:  ANNIE L. MATTINGLY
13. BIRTHPLACE OF MOTHER:  KENTUCKY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JOE BEAVIN
(Address)  CLOVERPORT KY
15. Filed  DEC. 28, 1913
REGISTAR:  ILMALTO
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  DEC 27, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  MAR 14, 1913 TO DEC 27, 1913     
That I last saw him/her alive on (date):  ALIVE NOV 15, 1913
And that death occurred on the date stated above at (time AM/PM):  3 PM
THE CAUSE OF DEATH was as follows:   TUBUCULOSIS PULMONATIS
 
(Duration)   Years:   1      Months:            Days:   PERTUSSIS
Contributory:  
 
(Duration)   Years:            Months:   3         Days:   15
Signed (M.D.):  F.L. LIGHTFOOT
Date:   DEC 28, 1913
Address:  CLOVERPORT,  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:   HARDINSBURG, KY
DATE OF BURIAL:  DEC 29, 1913
20. UNDERTAKER:  M. HAMMAN SONS
ADDRESS:  CLOVERPORT, KY
 

ADDITIONAL COMMENTS/NOTES:




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Copyright.  All rights reserved.
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