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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  McMDANIELS
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5318
Primary Registration District No:  
File No.  12276
Registered No:  
2.	FULL NAME:  KIPER, ELNORA
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  MAR 24, 1912
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 / 2 / 3
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  JOHN M. KIPER
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MINNIE MAY HORNBACK
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J.M. KIPER
(Address)  FRANKS, KY
15.	Filed  MAY 31, 1913
REGISTAR:  M.M. JACKSON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 27, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  APRIL 1913 to MAY 11, 1913
That I last saw him/her alive on (date):  MAY 11, 1913
And that death occurred on the date stated above at (time AM/PM):  2:30 PM
THE CAUSE OF DEATH was as follows:  ENLARGEMENT OF THE LIVER PROBABLY OF TUBERCULAR ORIGIN
(Duration)   Years:            Months:     ABT 3 MOS       Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.B. LAMPTON
Date:  MAY 30, 1913
Address:  McDANIELS
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:  NO INFORMATION PROVIDED
DATE OF BURIAL:  
20.	UNDERTAKER:  
ADDRESS:  


ADDITIONAL COMMENTS/NOTES:




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