1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Custer
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  
File No.  20138
Registered No:  
2. FULL NAME:  Marlow, Emerie
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  August 3, 1835
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  75 yr 11 mo 30 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housework
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  William Carter
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Lucretia Scott
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Thomas Marlow
(Address)  Big Spring, KY
15. Filed  Aug. 4, 1911
REGISTAR:  R. O. Penick
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Aug. 2, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 8, 1911
That I last saw him/her alive on (date):  Aug. 2, 1911
And that death occurred on the date stated above at (time AM/PM): 5 PM 
THE CAUSE OF DEATH was as follows:  Chronic Pericarditis

(Duration)   Years:            Months:            Days:  
Contributory:  Paralysis

(Duration)   Years:            Months:            Days:  
Signed (M.D.): J. W. Meador
Date:  Aug. 3, 1911
Address:  Custer, 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:  Kasey Grave Yd.
DATE OF BURIAL:  Aug. 4, 1911
20. UNDERTAKER:  R. O. Penick
ADDRESS:  Custer, KY