************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HARDINSBURG Inc Town: City: No. St. Ward: 2ND Registration District No.: Primary Registration District No: File No. 30570 Registered No: 72 2. FULL NAME: MATTINGLY, KATIE MABEL PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: SINGLE 6. DATE OF BIRTH: DEC 28, 1890 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 20 / 11 /19 8. OCCUPATION (a.) Trade, profession or particular kind of work: HOUSEWORK 9. (b.) General nature of industry business or establishment which employed: WITH PARENTS 10. BIRTHPLACE: PATESVILLE, HANCOCK CO 11. NAME OF FATHER: CHARLES MATTINGLY 12. BIRTHPLACE OF FATHER: PATESVILLE, HANCOCK CO 13. MAIDEN NAME OF MOTHER: ELLA PRICE 14. BIRTHPLACE OF MOTHER: PATESVILLE, HANCOCK CO 15. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) EARL MATTINGLY (Address) GARFIELD, KY 16. Filed DEC 19, 1911 REGISTAR: W.B. LENNON MEDICAL CERTIFICATE OF DEATH 17. DATE OF DEATH: DEC 17, 1911 18. I HEREBY CERTIFY, That I attended deceased from (date): AUG 10, 1911 to DEC 17, 1911 That I last saw him/her alive on (date): 15 DEC 191 And that death occurred on the date stated above at (time AM/PM): 5 PM THE CAUSE OF DEATH was as follows: CONSUMPTION (Duration) Years: 5 Months: 7 Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.A. SANDBACH Date: DEC 18, 1911 Address: GARFIELD 19. 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: 20. PLACE OF BURIAL OR REMOVAL: GARFIELD CEM DATE OF BURIAL: DEC 18, 1911 21. UNDERTAKER: J.B. RICHARDSON ADDRESS: GARFIELD ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************