1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.:
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5308
File No. 16548
Registered No: 23
1. FULL NAME: William McMillen
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: yes
5. DATE OF BIRTH: August 19th, 1827
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 84yrs11mos
7. OCCUPATION (a.) Trade, profession or particular kind of work: merchant
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Rome, Ind
9. NAME OF FATHER: Johnson McMillen
10. BIRTHPLACE OF FATHER: Virginia
11. MAIDEN NAME OF MOTHER: Mary Luisa
12. BIRTHPLACE OF MOTHER: Virginia
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) J.W. McMillen
(Address)  Evansville, Ind
14. Filed July 24, 1912
REGISTAR: RA Shellman
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: July 23, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Feb 2, 1912 to July 22, 1912
That I last saw him/her alive on (date): July 22, 1912
And that death occurred on the date stated above at (time AM/PM): 2PM
THE CAUSE OF DEATH was as follows:
Heart lesions
(Duration)
Years: 2
Months:
Days:
Contributory: age & general debility
Signed (M.D.): Geo E. Shively
Date: July 24, 1912
Address: Stephensport, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Stephensport, Ky
DATE OF BURIAL: 7/24/1912
19. UNDERTAKER: W.J. Schopp
ADDRESS: Stephensport