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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HUDSON			
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5613
Primary Registration District No:  
File No.  422
Registered No:  1
2.	FULL NAME:  JOHNSON, SARAH GIVEN
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOW
6.	DATE OF BIRTH:  JAN 6, 1833
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  82 / - / 5
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWIFE
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  HARDIN COUNTY
10.	NAME OF FATHER:  HIRAM GIVEN
11.	BIRTHPLACE OF FATHER:  NOT GIVEN
12.	MAIDEN NAME OF MOTHER: NANCY YOUNG 
13.	BIRTHPLACE OF MOTHER:  NOT KNOWN
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  DOUGLAS GOODMAN
(Address)  HARDIN SPRINGS
15.	Filed 
REGISTAR:  FEB 10, 1915
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: JAN 1, 1915 
17.	I HEREBY CERTIFY, That I attended deceased from (date):  
That I last saw him/her alive on (date):  NOT LEGIBLE - 1914
And that death occurred on the date stated above at (time AM/PM):  3:30 PM
THE CAUSE OF DEATH was as follows:  OLD AGE
(Duration)   Years:            Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): H.C. STONE 
Date:  JAN 2, 1915
Address:  CONSTANTINE
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:  MT OLIVE
DATE OF BURIAL:  JAN 3, 1915
20.	UNDERTAKER:  
ADDRESS:  


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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