1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Moodyville
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5310
Primary Registration District No:  
File No.  38819
Registered No:  5310
2. FULL NAME:  Manning, Emma
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  Nov. 7, 1844
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  66 yr 4 mo 15 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  Simeon Clark
11. BIRTHPLACE OF FATHER:  Maryland
12. MAIDEN NAME OF MOTHER:  Mary Ann Matingley
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. N. Wobin
(Address)  Chenault, KY
15. Filed  Apr. 22 1911
REGISTAR:  Jimmie Cunningham
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Apr 22, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 7, 1909
That I last saw him/her alive on (date):  Apr 18, 1911
And that death occurred on the date stated above at (time AM/PM):  4:35 PM
THE CAUSE OF DEATH was as follows:  Cancer of the breast

(Duration)   Years:      2      Months:   1         Days:  11
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  D. S. Spire
Date:  Apr 22 1911
Address:  Moodyville
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:  Flint Island
DATE OF BURIAL:  Apr 23, 1911
20. UNDERTAKER:  J. Grover Hayden
ADDRESS:  Chenault, KY