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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  McDaniels
Inc Town:  
City:  McDaniels, Ky
No.  
St.  
Ward:  
Registration District No.:  5318
Primary Registration District No:  
File No.  21028
Registered No:  
2.	FULL NAME:  Stella Rae Jarboe
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6.	DATE OF BIRTH:  Sept. 15, 1892
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  21 yrsa  11 mos  9 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Teacher
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  McDaniles, Ky Breckinridge
10.	NAME OF FATHER:  
11.	BIRTHPLACE OF FATHER:  Breckinridge
12.	MAIDEN NAME OF MOTHER:  Laura E. Dockery
13.	BIRTHPLACE OF MOTHER:  Grayson Co.
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Blauche Jarboe
(Address)  McDaniels, Ky
15.	Filed  Aug 30, 1913
REGISTAR:  M. M. Jarboe
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  August 24, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  June 15, 1913 to Aug. 24, 1913
That I last saw him/her alive on (date):  Sun. Aug. 24, 1913
And that death occurred on the date stated above at (time AM/PM):  3:40 p.m.
THE CAUSE OF DEATH was as follows:  Tuberculosis

(Duration)   Years:            Months:   8         Days:  
Contributory:  Malaria & cessation of menses

(Duration)   Years:            Months:  4          Days:  
Signed (M.D.):  J. C. Tucker, M.D.
Date:  Aug. 1913
Address:  McDaniels, 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:  McDaniels, Ky
DATE OF BURIAL:  Aug. 25, 1913
20.	UNDERTAKER:  F. J. Rhodes
ADDRESS:  McDaniels


ADDITIONAL COMMENTS/NOTES:




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