1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hudson
Inc Town: 
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5316
File No. 29332
Registered No: 16
1. FULL NAME: Henry Mercer
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: June23, 1912
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 4mos
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Ky
9. NAME OF FATHER: John E Mercer
10. BIRTHPLACE OF FATHER: Ky
11. MAIDEN NAME OF MOTHER: Laura Carwile
12. BIRTHPLACE OF MOTHER: Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) John E Mercer
(Address) Eveleigh, Ky
14. Filed 12/18/1912
REGISTAR: JH Comer
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Oct 23, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Sept 9, 1912 to Oct 23,1912
That I last saw him/her alive on (date): Oct 22, 1912
And that death occurred on the date stated above at (time AM/PM): 8AM
THE CAUSE OF DEATH was as follows:
Inanition
(Duration)
Years:
Months: 8
Days:
Signed (M.D.): J.E. Hale
Date:  
Address: Hardin Springs, 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
DATE OF BURIAL:
19. UNDERTAKER:
ADDRESS: