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1.	PLACE OF DEATH
County:  Breckinridge Co., Ky
Vot. Pol.:  5306
Inc Town:  Cloverport, Ky
City:  
No.  
St.  
Ward:  2nd 
Registration District No.:  131
Primary Registration District No:  
File No.  15007
Registered No:  110
2.	FULL NAME:  William D. Jarboe
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Male
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.	DATE OF BIRTH:  April 27, 1882
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  31 yrs  1 mos  23 ds
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Watchman
(b.)  General nature of industry business or establishment which employed:  R. R. Shope
9.	BIRTHPLACE:  Kentucky
10.	NAME OF FATHER:  Walter Jarboe
11.	BIRTHPLACE OF FATHER:  Kentucky
12.	MAIDEN NAME OF MOTHER:  Prudence Bland
13.	BIRTHPLACE OF MOTHER:  Kentucky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. Annie E. Jarboe
(Address)  Cloverport, Ky
15.	Filed  June 20, 1913
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  June 2o, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  April 1st , 1913 to June 20th , 1913
That I last saw him/her alive on (date):  June 10th , 1913
And that death occurred on the date stated above at (time AM/PM):  4:40 a.m.
THE CAUSE OF DEATH was as follows:  Laryngeal Tuberculosis

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

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. R. Lightfoot, M.D.
Date:  June 20, 1913
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:  St. Rose Cem.
DATE OF BURIAL:  June 21, 1913
20.	UNDERTAKER:  M. Hamman Sons
ADDRESS:  Cloverport, Ky


ADDITIONAL COMMENTS/NOTES:




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