1. PLACE OF DEATH County: Breckinridge Vot. Pol.: 5306 Inc Town: Cloverport, Ky City: No. St. Ward: 2nd Registration District No.: 131 Primary Registration District No: File No. 16546 Registered No: 67 1. FULL NAME: Ella Miller PERSONAL AND STATICAL PARTICULARS 2. SEX: female 3. COLOR OR RACE: white 4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married 5. DATE OF BIRTH: Dec 25, 1869 6. AGE (yr. mo. da) (If less than 1 day, hours or min?): 42yrs6mos8ds 7. OCCUPATION (a.) Trade, profession or particular kind of work: house work (b.) General nature of industry business or establishment which employed: 8. BIRTHPLACE: Ind 9. NAME OF FATHER: John Castil 10. BIRTHPLACE OF FATHER: Ind 11. MAIDEN NAME OF MOTHER: don’t know 12. BIRTHPLACE OF MOTHER: don’t know 13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Walter Meadow (Meador?) (Address) Cloverport, Ky 14. Filed July 3, 1912 REGISTAR: JC Nolte MEDICAL CERTIFICATE OF DEATH 15. DATE OF DEATH: July 3, 1912 16. I HEREBY CERTIFY, That I attended deceased from (date): June 1, 1912 to July 1, 1912 That I last saw him/her alive on (date): June 28, 1912 And that death occurred on the date stated above at (time AM/PM): 8AM THE CAUSE OF DEATH was as follows: Tuberculosis (Duration) Years: 5 Months: Days: Contributory: deep coed.(?) Signed (M.D.): J.T. Owen for Nolte Date: July 3, 1912 Address: Cloverport, 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: Taul’s grave yard, Breckinridge Co, Ky DATE OF BURIAL: July 4, 1912 19. UNDERTAKER: M Hamman sons ADDRESS: Cloverport , Ky