1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg
Inc Town: Hardinsburg
City:
No.
St.
Ward: 1
Registration District No.: 130
Primary Registration District No:
File No. 2951
Registered No: 11
1. FULL NAME: Elizabeth Miller
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white 
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: widowed
5. DATE OF BIRTH: 12/18/1844
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 66yrs1mo21ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: none
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Peter Lyons
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Dorcas Riley Williams
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Wm. Miller
(Address) Kirk, Ky
14. Filed Feb 9, 1911
REGISTAR: HB Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: 2/8/1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Jan 22, 1911 to Feb 8, 1911
That I last saw him/her alive on (date): Feb 6, 1911
And that death occurred on the date stated above at (time AM/PM): 2PM
THE CAUSE OF DEATH was as follows:
Pulmonary Tuberculosis
(Duration)
Years: 10
Months:
Days:
Signed (M.D.): Jno E Kincheloe
Date: Feb 8, 1911
Address: Hardinsburg
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: Miller Cemetery
DATE OF BURIAL: 2/8/1911
19. UNDERTAKER: Pete Sheeran Bro Co 
ADDRESS: Kirk, Ky