1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  5301
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5301
File No.  14255
Registered No: 31 
2. FULL NAME:  Mattingly, Athauthis Norbit
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  June 6, 1879
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  32 yr 0 mo 1 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farming
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  John Henry Mattingly
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Emma Mattingly
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J. B. Mattingly
(Address)  Westview, KY
15. Filed  June 7, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  June 7, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan. 16, 1911
That I last saw him/her alive on (date):  May 28, 1911
And that death occurred on the date stated above at (time AM/PM):  10:15 AM
THE CAUSE OF DEATH was as follows:  Suppurative pancreatitis

(Duration)   Years:            Months:    5        Days:  
Contributory:  Gastroduodenititis

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. E. Matthews
Date:  June 7, 1911
Address:  Westview, 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:  St. Romauld's Cemetery
DATE OF BURIAL:  June 8, 1911
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg, KY