1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: 8
Inc Town: Stephensport
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5308
File No. 29813
Registered No:
1. FULL NAME: Aron Miller
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: July 27, 1836
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 76yrs6mos
7. OCCUPATION (a.) Trade, profession or particular kind of work: carpenter
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co, Ky
9. NAME OF FATHER: AR Miller
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Sallie Huckely
12. BIRTHPLACE OF MOTHER: 
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) E.H. Miller
(Address) Stephensport, Ky
14. Filed Dec 24, 1912
REGISTAR: R.A. Shellman
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Dec 23, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Dec 16, 1912 to Dec 23, 1912
That I last saw him/her alive on (date): Dec 22, 1912
And that death occurred on the date stated above at (time AM/PM): 1 AM
THE CAUSE OF DEATH was as follows:
LaGrippe
(Duration)
Years:
Months:
Days: 7
Contributory: age & heart weakness 
Signed (M.D.): Geo E. Shively
Date: Dec 25, 1912
Address: Stephensport
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 : (something written but crossed out) Ky
DATE OF BURIAL: Dec 24, 1912
19. UNDERTAKER: W.J. Schopp
ADDRESS: Stephensport, Ky