************************************************************************ 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.: 5305 Inc Town: City: CLOVERPORT No. St. Ward: 1st Registration District No.: 131 Primary Registration District No: 2065 File No. 17461 Registered No: 158 2. FULL NAME: MATTINGLY, MARY JANE BEAVIN PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: JUN 7, 1841 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 73 / 0 / 26 8. OCCUPATION (a.) Trade, profession or particular kind of work: HOUSEKEEPER (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: BRECKINRIDGE 10. NAME OF FATHER: AUSTIN BEAVIN 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: MARY J. BEAVIN 13. BIRTHPLACE OF MOTHER: BRECKINRIDGE 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) JAMES C. MATTINGLY (Address) CLOVERPORT 15. Filed JUL 4, 1914 REGISTAR: J.C. NOLTE MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: JUL 3, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): MAY 1, 1914 to JUL 3, 1914 That I last saw him/her alive on (date): JUL 3, 1914 And that death occurred on the date stated above at (time AM/PM): 6:30 PM THE CAUSE OF DEATH was as follows: PARALYSIS FOLLOWED BY UREMIA (Duration) Years: Months: 2 Days: 2 Contributory: GENERAL DEBILITY (Duration) Years: Months: Days: Signed (M.D.): F.L. LIGHTFOOT Date: JUL 3, 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: HARDINSBURG DATE OF BURIAL: JUL 4, 1914 20. UNDERTAKER: M. HAMMONS & SON 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 ************************************************************************