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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CLOVERPORT
Inc Town:  
City:  
No.  
St.  
Ward:  1
Registration District No.:  131
Primary Registration District No:  3065
File No.  28694
Registered No: 129 
2. FULL NAME:  MATTINGLY, LORENA
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  JAN 7, 1893
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  20 YR 10 MO
8. OCCUPATION (a.) Trade, profession or particular kind of work:  TELEGRAPH OPERATOR
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  R. T. MATTINGLY
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  BRIDGET SHERRON
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R. T. MATTINGLY
(Address)  CLOVERPORT, KY
15. Filed  NOV. 18, 1913
REGISTRAR:  J. C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  NOV 17, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  JUNE 1, 1913
That I last saw him/her alive on (date):  NOV 10, 1913
And that death occurred on the date stated above at (time AM/PM):  6 PM
THE CAUSE OF DEATH was as follows:  PULMONARY TUBERCULOSIS

(Duration)   Years:     1       Months:            Days:  
Contributory:  HEREDITARY AND EXPOSURE

(Duration)   Years:     2       Months:            Days:  
Signed (M.D.):  C. R. LIGHTFOOT
Date:  NOV. 18, 1913
Address:  CLOVERPORT, 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:  BRECKINRIDGE CO., KY
DATE OF BURIAL:  NOV. 19, 1913
20. UNDERTAKER:  M. HAMMON SONS
ADDRESS:  CLOVERPORT, KY

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