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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  5305
Inc Town:  C [crossed out]
City:  Cloverport, Ky
No.  
St.  
Ward:  1 st
Registration District No.:  131
Primary Registration District No:  2065
File No.  9447
Registered No:  141
2. FULL NAME:  Mrs. Eliza Ellenor Gregory
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  January 12
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  67 years, 2 months, 22 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeper
(b.)  General nature of industry business or establishment which employed:  General House Work
9. BIRTHPLACE:  Indiana
10. NAME OF FATHER:  Nelson Ryan
11. BIRTHPLACE OF FATHER:  New York
12. MAIDEN NAME OF MOTHER:  Louise Cockerell
13. BIRTHPLACE OF MOTHER:  Indiana
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. Jessie Hudson
(Address)  Versailes, Ky
15. Filed  April 4, 1914
REGISTAR:  J.C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  April 4, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  Mar 31 to Apr 4, 1914
That I last saw him/her alive on (date):  April 4, 1914
And that death occurred on the date stated above at (time AM/PM):  12:30 PM
THE CAUSE OF DEATH was as follows:  Information Stomach and Bowels
 
(Duration)   Years:            Months:            Days:  5
Contributory:  Congestion Stomach
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.T. Owen
Date:  April 4, 1914
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:  Cloverport, Ky
DATE OF BURIAL:  April 5, 1914
20. UNDERTAKER:  M. Hammon & Son
ADDRESS:  Cloverport, Ky
 

ADDITIONAL COMMENTS/NOTES:
Breckinridge County Cemeteries Volume 1, page 180 says that Eliza Ryan Gregory is buried at Cloverport Cemetery #1. The stone reads 1848 - 1914
 
 

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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