************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward:  4th
Registration District No.:  130
Primary Registration District No:  5304
File No.  
Registered No:  25204
2.	FULL NAME:  LASLIE, MOLLIE ANN JOLLY
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  WIDOW
6.	DATE OF BIRTH:  OCT 6, 1846
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  67 / 10 / 8
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPING
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  PETER JOLLY
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MIRIAM STELLAN  [SP]
13.	BIRTHPLACE OF MOTHER:  ILLEGIBLE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  H__IE WORDIS JR. [INK SPLOTCH]
(Address)  HARDINSBURG
15.	Filed  OCT 18, 1914
REGISTAR:  W.B. LENNON
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 17, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  OCT 11, 1914 to OCT 17, 1914
That I last saw him/her alive on (date):  OCT 11, 1914
And that death occurred on the date stated above at (time AM/PM):  6 1/4 pm  [6:15]
THE CAUSE OF DEATH was as follows:  CARDIAC ARTHANA [ARRYTHMIA]
(Duration)   Years:            Months:    9        Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A.M. KINCHLOE
Date:  OCT 17, 1914
Address:  HARDINSBURG
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:  BEN MILLER CEMETERY
DATE OF BURIAL:  OCT 18, 1914
20.	UNDERTAKER:  B.F. BEARD
ADDRESS:  HARDINSBURG


ADDITIONAL COMMENTS/NOTES:




************************************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************