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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Cloverport, Ky
Inc Town:  5306
City:  
No.  
St.  
Ward:  
Registration District No.:  131
Primary Registration District No:  5306
File No.  26156
Registered No:  126
2. FULL NAME:  Emma Alice Hardin
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  Sept 13, 1851
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  62 years, 1 month, 17 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeping
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Indiana
10. NAME OF FATHER:  John Horatio Blythe
11. BIRTHPLACE OF FATHER:  probably Wales
12. MAIDEN NAME OF MOTHER:  Adelia Militant Rodd
13. BIRTHPLACE OF MOTHER:  Virginia
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Orrin Hardin
(Address)  Cloverport, Ky
15. Filed  Oct 30
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  10 - 3 - 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  Oct 25 to Oct 30, 1913
That I last saw him/her alive on (date):  Oct 28, 1913
And that death occurred on the date stated above at (time AM/PM):  2 PM
THE CAUSE OF DEATH was as follows:  Carcinoma of Uterus
 
(Duration)   Years:            Months:            Days:  I do not know
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. M. Kincheloe
Date:  Oct 30, 1913
Address:  hardinsburg, 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:  Oct 31, 1913
20. UNDERTAKER:  M. Hammon & Son
ADDRESS:  Cloverport, Ky
 

ADDITIONAL COMMENTS/NOTES: Breckinridge County Cemetery Book, Volume 1: Emma Blythe Hardin, wife of Julius, is buried in Cloverport Cemetery #1, in Cloverport.
 
 
 

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