************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: 5307 Inc Town: City: CLOVERPORT No. St. Ward: Registration District No.: 131 Primary Registration District No: 2065 File No. 30818 Registered No: 177 2. FULL NAME: MATTINGLY, MARTHA J. WHEATLEY PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: NOV 19, 1854 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 60 / 0 / 25 8. OCCUPATION (a.) Trade, profession or particular kind of work: HOUSEWIFE (b.) General nature of industry business or establishment which employed: GENERAL HOUSEWORK 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: JOSEPH WHEATLEY 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: MARY ASKINS 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) C.F. MATTINGLY (Address) CLOVERPORT 15. Filed DEC 15, 1914 REGISTAR: J.C. NOLTE MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: DEC 14, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): JUN 1914 to DEC 14, 1914 That I last saw him/her alive on (date): DEC 14, 1914 And that death occurred on the date stated above at (time AM/PM): 11:45 AM THE CAUSE OF DEATH was as follows: CANCER SINUS or CARCINOMA SINUS (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): A.A. TIMONS Date: DEC 15, 1914 Address: CLOVERPORT 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: CLOVERPORT CEM DATE OF BURIAL: DEC 16, 1914 20. UNDERTAKER: M.HAMMONS & SONS ADDRESS: CLOVERPORT ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************