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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  5305
Inc Town:  
City:  CLOVERPORT
No.  
St.  
Ward: 1
Registration District No.:  131
Primary Registration District No:  
File No.  37960
Registered No:  176
2. FULL NAME:  HAWKINS, HARRY MCD.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  JUNE 20, 1914
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  0 YR  5 MO 9 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  R. E. HAWKINS
11. BIRTHPLACE OF FATHER:  INDIANA
12. MAIDEN NAME OF MOTHER:  NANNIE PIERCE
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R. E. HAWKINS
(Address)  HOLT, KY
15. Filed  NOV. 30, 1914
REGISTRAR:  J. C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: NOV. 29, 1914 
17. I HEREBY CERTIFY, That I attended deceased from (date):  OCT. 31, 1914
That I last saw him/her alive on (date):  NOV. 28, 1914
And that death occurred on the date stated above at (time AM/PM):  2:15 AM
THE CAUSE OF DEATH was as follows:  CHOLERA INFANTUM

(Duration)   Years:            Months:     1      Days:  6 
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E. C. MCDONALD
Date:  NOV. 30, 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:  BRECKINRIDGE CO., KY
DATE OF BURIAL:  NOV. 30, 1914
20. UNDERTAKER:  M. HAMMAN
ADDRESS:  CLOVERPORT, KY