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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CUSTER
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  
File No.  15016
Registered No:  50
2. FULL NAME:  MEADOR, KATE
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  FEB 23, 1890
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  23 YR 3 MO 24 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEWIFE
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  BRECKINRIDGE CO., KY
10. NAME OF FATHER:  ELISHA SIMMONS
11. BIRTHPLACE OF FATHER:  VA
12. MAIDEN NAME OF MOTHER:  ? BRUINGTON
13. BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO., KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R. W. MEADOR
(Address)  CUSTER, KY
15. Filed  JUNE 1913
REGISTRAR:  J. T. MITCHAM
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JUNE 17, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  JUNE 13, 1913
That I last saw him/her alive on (date):  JUNE 17, 1913
And that death occurred on the date stated above at (time AM/PM):  10 PM
THE CAUSE OF DEATH was as follows:  NEPHRITIS

(Duration)   Years:            Months:            Days:  5
Contributory:  GESTATION

(Duration)   Years:            Months:   4 1/2         Days:  
Signed (M.D.):  S. J. HALL
Date:  JUNE 17, 1913
Address:  CONSTANTINE, 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:  GARFIELD, KY
DATE OF BURIAL:  JUNE 18, 1913
20. UNDERTAKER:  ?
ADDRESS:  

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