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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  MeDaniels
Inc Town:  
City:  
No.  
St.  
Ward  
Registration District No.:  5318
Primary Registration District No:  
File No.  5641
Registered No:  18
2.	FULL NAME:  Mrs. Nannie F. Glasscock
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  Nov. 30, 1846
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  65 yrs  3 mos  
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Housekeeper
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Ky
10.	NAME OF FATHER:  George C. LeGrand
11.	BIRTHPLACE OF FATHER:  Ky
12.	MAIDEN NAME OF MOTHER:  Nancy H. Bridwell
13.	BIRTHPLACE OF MOTHER:  Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Ezra E. Glasscock
(Address)  Kingswood, Ky
15.	Filed  Mc 30, 1911
REGISTAR:  M. M. Jarboe
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  March 30, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Mch 25, 1911 to Mch 30, 1911
That I last saw him/her alive on (date):  Mch 30, 1911
And that death occurred on the date stated above at (time AM/PM):  6:35 p.m.
THE CAUSE OF DEATH was as follows:  Pnemonia

(Duration)   Years:       Months:       Days:  3                                                          
Contributory:  to acute Bronchitis
(Duration)   Years:       Months:       Days:
Signed (M.D.):  J. E. Matthews, M.D.
Date:  Mch 30, 1911
Address:  Westview, 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  
DATE OF BURIAL:  
20.	UNDERTAKER:  
ADDRESS:  

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Copyright.  All rights reserved.
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