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NOTE: Some dates were written 1913, but are clearly 1914, and were corrected in this transcription.


1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:
Registration District No.:  
Primary Registration District No:  
File No.  55784
Registered No:  5312
2. FULL NAME:  HARDESTY, JOSEPH
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  OCT. 31, 1857
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  56 YR 2 MO 2 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  JAMES HARDESTY
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  TERESA FACKLER
13. BIRTHPLACE OF MOTHER:  GERMANY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  TOM HARDESTY
(Address)  IRVINGTON
15. Filed JAN. 2, 1914
REGISTRAR:  D. W. HENRY
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JAN. 2, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  DEC. 29, 1913
That I last saw him/her alive on (date):  JAN. 2, 1914
And that death occurred on the date stated above at (time AM/PM):  11 PM
THE CAUSE OF DEATH was as follows:  PNEUMONIA

(Duration)   Years:            Months:           Days:  5
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. A. BAXTER
Date:  JAN. 2, 1914
Address:  GUSTON, 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:  MT. ??
DATE OF BURIAL:  JAN. 3, 1914
20. UNDERTAKER:  G. T. MARSHALL
ADDRESS:  IRVINGTON