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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Cloverport, KY
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  130
Primary Registration District No:  5302
File No.  11887
Registered No:  97
2. FULL NAME:  Mollie McClelland
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married
6. DATE OF BIRTH:  Jan 2, 1875
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  37 years, 4 months, 17 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  at home
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Matt
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  [unreadable]
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  John M. McClelland
(Address)  Cloverport, KY
15. Filed  May 14, 1912
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  May 14, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 5 to May 14, 1912
That I last saw him/her alive on (date):  May 14, 1912
And that death occurred on the date stated above at (time AM/PM):  3:10 am
THE CAUSE OF DEATH was as follows:  
 
(Duration)   Years:            Months:            Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Jno. E. Kincheloe
Date:  May 14, 1912
Address:  Hardinsburg, 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:  St Romuald Cemetery
DATE OF BURIAL:  May 15, 1912
20. UNDERTAKER:  Jno, T. Hoben
ADDRESS:  Hardinsburg
 

ADDITIONAL COMMENTS/NOTES:Breckinridge County Cemeteries, Volume 1, page 292 lists Mollie D. McClelland as buried in St. Romuald Cemetery, Highway 259. Cemetery lies between the Parish Church and the northern limit of the city of Hardinsburg, KY.
 
 
 

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