1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  
Inc Town:  STEPHENSPORT
City:  
No.  
St.  
Ward:
Registration District No.:  
Primary Registration District No:  5308
File No.  9451
Registered No:  51
2. FULL NAME:  MILLER, ELIJAH HUCKEBY
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  FEB. 27, 1845
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  69 YR 1 MO 9 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  BLACKSMITH
(b.)  General nature of industry business or establishment which employed:  WAGON SHOP
9. BIRTHPLACE:  BRECKINRIDGE CO., KY
10. NAME OF FATHER:  AARON MILLER
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  SARAH HUCKEBY
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  F. C. FERRY
(Address)  LOUISVILLE, KY
15. Filed  APR. 6, 1914
REGISTRAR:  R. A. SHELLMAN
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  APR. 4, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  MAR. 31, 1914
That I last saw him/her alive on (date):  APR. 4, 1914
And that death occurred on the date stated above at (time AM/PM):  12:13 AM
THE CAUSE OF DEATH was as follows:  ANGINA PECTORIS

(Duration)   Years:            Months:           Days:  
Contributory:  OVER ???

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  B. H. PARRISH
Date:  APR. 4, 1914
Address:  STEPHENSPORT, 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:  STEPHENSPORT, KY
DATE OF BURIAL:  APR. 6, 1914
20. UNDERTAKER:  C. A. TIMMS
ADDRESS:  STEPHENSPORT, KY