1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  UNION STAR
Inc Town:  
City:  
No.  
St.  
Ward:
Registration District No.: 5309 
Primary Registration District No:  
File No.  17469
Registered No: 7 
2. FULL NAME:  MILNER, MATTIE CLYDE
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  DEC. 2, 1877
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  36 YR, 7 MO 29 DA
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  BRECKINRIDGE CO., KY
10. NAME OF FATHER:  WILLIAM MILNER
11. BIRTHPLACE OF FATHER:  FARFOR, SCOTLAND
12. MAIDEN NAME OF MOTHER:  MATILDA HELEN
13. BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO., KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  WILLIAM L. MILNER
(Address)  UNION STAR, KY
15. Filed  AUG. 6, 1914
REGISTRAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JULY 31, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  MAY 20, 1914
That I last saw him/her alive on (date):  JULY 31, 1914
And that death occurred on the date stated above at (time AM/PM):  4:45 AM
THE CAUSE OF DEATH was as follows:  CHRONIC TYPHOID

(Duration)   Years:            Months:   6        Days:  
Contributory:  INFLAMMATION OF GALL BLADDER

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  WILLIAM L. MILNER
Date:  JULY 31, 1914
Address:  UNION STAR, 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:  UNION STAR
DATE OF BURIAL:  AUG 1, 1914
20. UNDERTAKER:  D. S. RICHARDSON
ADDRESS:  UNION STAR