1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Union Star Inc Town: City: No. St. Ward: Registration District No.: 5309 Primary Registration District No: File No. 6184 Registered No: 5 2. FULL NAME: Hesler [stillborn] PERSONAL AND STATICAL PARTICULARS 3. SEX: Male 4. COLOR OR RACE: White 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: 6. DATE OF BIRTH: Mar 27, 1912 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 8. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: Breckinridge Co., KY 10. NAME OF FATHER: George Hesler 11. BIRTHPLACE OF FATHER: Meade Co., KY 12. MAIDEN NAME OF MOTHER: Virginia Rollins 13. BIRTHPLACE OF MOTHER: Breckinridge Co., KY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) George Hesler (Address) Union Star, KY 15. Filed Mar 28, 1912 REGISTRAR: Lee Stewart MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Mar 27, 1912 17. I HEREBY CERTIFY, That I attended deceased from (date): Mar 27, 1912 That I last saw him/her alive on (date): Never And that death occurred on the date stated above at (time AM/PM): 3 am THE CAUSE OF DEATH was as follows: Stillborn (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): William L. Milner Date: Mar 28, 1912 Address: Union Star, 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: DATE OF BURIAL: Mar 28, 1912 20. UNDERTAKER: ADDRESS: