1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  9
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  
File No.  11897
Registered No: 8 
2. FULL NAME:  Hardesty, Lillian J.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Aug 12, 1889
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  22 ye 9 mo 8 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Meade Co., KY
10. NAME OF FATHER:  Joseph Fackler
11. BIRTHPLACE OF FATHER:  Germany
12. MAIDEN NAME OF MOTHER:  Josephine Elder
13. BIRTHPLACE OF MOTHER:  Breckinridge Co., KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Joseph Fackler
(Address)  
15. Filed  May 30, 1912
REGISTRAR:  Lee Stewart
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  May 20, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Apr 9, 1912
That I last saw him/her alive on (date):  May 16, 1912
And that death occurred on the date stated above at (time AM/PM):  4:30 am
THE CAUSE OF DEATH was as follows:  Heart failure believed to be due to embolism due to puerperal state

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  T. H. Hardesy
Date:  May 20, 1912
Address:  Paynesville, 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. Moreno
DATE OF BURIAL:  May 21, 1912
20. UNDERTAKER:  G. T. Marshall
ADDRESS:  Irvington, KY