************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  5307
Inc Town:  C
City:  Cloverport, Ky
No.  
St.  
Ward:  3
Registration District No.:  
Primary Registration District No:  
File No.  21017
Registered No:  121
2. FULL NAME:  Mrs. Mary E Lewis
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married
6. DATE OF BIRTH:  Dec 10, 1869
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  43 years, 8 months, 18 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeper
(b.)  General nature of industry business or establishment which employed:  General House Work
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  James Mattingly
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Elizabeth leHigh
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Henry Lewis
(Address)  Cloverport, Ky
15. Filed  August 29,  1913
REGISTAR:  J.C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  August 28, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  August 20 to August 28, 1913
That I last saw him/her alive on (date):  August 28, 1913
And that death occurred on the date stated above at (time AM/PM):  9:45 PM
THE CAUSE OF DEATH was as follows:  Cerebral Hemorrhage
 
(Duration)   Years:            Months:            Days:  7
Contributory:  Chronic Nephrosis
 
(Duration)   Years:     2       Months:            Days:  
Signed (M.D.):  E. C. McDonald, MD
Date:  August 29, 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:  Breckenridge Co., KY
DATE OF BURIAL:  August 30, 1913
20. UNDERTAKER:  M. Hammon & Son
ADDRESS:  Cloverport, Ky
 

ADDITIONAL COMMENTS/NOTES: Breckenridge County Cemeteries Volume 1, Page 264 shows Mary Elizabeth Lewis, wife of Henry Joseph buried in Calvary Cemetery, the new St. Rose Cemetery, on a bluff in the city limits of Cloverport, Ky.  Born 12/10/1866, died 8/25/1913.
 
 
 

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