1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  5307
Inc Town:  Cloverport, Ky
City:  
No.  
St.  
Ward:  3
Registration District No.:  
Primary Registration District No:  
File No.  20127
Registered No:  33
2.	FULL NAME:  Mary Mabel Haycraft
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  May 13, 1891
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  20 yrs, 4 mos, 7 days
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  House keeper
(b.)  General nature of industry business or establishment which employed:  General house work
9.	BIRTHPLACE:  Hancock Co, Ky
10.	NAME OF FATHER:  J. H. Probus
11.	BIRTHPLACE OF FATHER:  Grayson Co, Ky
12.	MAIDEN NAME OF MOTHER:  Margarite Jane Tindall
13.	BIRTHPLACE OF MOTHER:  Hancock, Co, Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J. H. Probus
(Address)  Cloverport, Ky
15.	Filed  Aug 20, 1911
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  August 20, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  July 22, 1911 to Aug 20, 1911
That I last saw her alive on (date):  Aug 16, 1911
And that death occurred on the date stated above at (time AM/PM):  12:15 am
THE CAUSE OF DEATH was as follows:  Acute Miliary Tuberculosis

(Duration)   Years:            Months:  8          Days:  20
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E.C. McDonald
Date:  Aug 20, 1911
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:  Dukes, Ky
DATE OF BURIAL:  Aug 20, 1911
20.	UNDERTAKER:  M. HAMMAN & Son
ADDRESS:  Cloverport