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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Rockvale, KY
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5320
Primary Registration District No:  
File No.  9527
Registered No:  
2. FULL NAME:  MATTINGLY, HENRY
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  APRIL 11, 1866
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  47 YR 0 MO 0 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  FARMER
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  JOHN MATTINGLY
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  FRANKS
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  C. E. HARLOW
(Address)  GLEN DEAN, KY
15. Filed  APR 24, 1913
REGISTRAR:  J. D. MCDONOUGH
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  APRIL 11, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  APR 1, 1913
That I last saw him/her alive on (date):  APR 10, 1913
And that death occurred on the date stated above at (time AM/PM):  2 AM
THE CAUSE OF DEATH was as follows:  LOBAR PNEUMONIA

(Duration)   Years:            Months:            Days:  10
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  P.E. DEMPSTER
Date:  APRIL 12, 1913
Address:  GLEN DEAN, 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:  ASKINS GRAVEYARD
DATE OF BURIAL:  APRIL 12, 1913
20. UNDERTAKER:  
ADDRESS:  

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net
 
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