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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  5307
Inc Town:  CLOVERPORT
City:  
No.  
St.  
Ward: 3
Registration District No.:  131
Primary Registration District No:  2065
File No.  6233
Registered No:  142
2. FULL NAME:  HARDIN, SILAS
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  BLACK
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:   RECORD LOST .. CA. 1860
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  CA. 53 YRS
8. OCCUPATION (a.) Trade, profession or particular kind of work:  LABORER
(b.)  General nature of industry business or establishment which employed:  RR YARD
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  JACOB HARDIN
11. BIRTHPLACE OF FATHER:  UNKNOWN
12. MAIDEN NAME OF MOTHER:  LUCY MCGAVOCK
13. BIRTHPLACE OF MOTHER:  VA
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  SHELBY HARDIN
(Address)  CLOVERPORT, KY
15. Filed  MAR. 13, 1914
REGISTRAR:  J. C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: MAR. 11, 1914 
17. I HEREBY CERTIFY, That I attended deceased from (date):  NOV. 1912
That I last saw him/her alive on (date):  AUG. 13, 1913
And that death occurred on the date stated above at (time AM/PM):  2 PM
THE CAUSE OF DEATH was as follows:  SARCOMA (1ST FOOT, 2ND THIGH). THIGH INFECTION DISCOVERED 8 MOS AFTER AMPUTATION OF LEG, UPPER THIGH

(Duration)   Years:  2       Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. A. SIMONS
Date:  MARCH 13, 1914
Address:  CLOVERPORT
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
DATE OF BURIAL:  MAR 13, 1914
20. UNDERTAKER:  M. HAMMON SONS
ADDRESS:  CLOVERPORT