1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Rockvall Pct
Inc Town:
City:
No. 5320
St.
Ward
Registration District No.: 132
Primary Registration District No:
File No. 2632
Registered No: 1
1. FULL NAME: Bettie C Moorman
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: Oct 3, 1847
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 63yrs3mos15ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: housewife
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co
9. NAME OF FATHER: William Owen
10. BIRTHPLACE OF FATHER: Breckinridge Co
11. MAIDEN NAME OF MOTHER: Sallie King
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) J.M. Craig
(Address) Vanzant, Ky
14. Filed 1/18/1911
REGISTAR: (written below line) Dennis Walker
	And in parenthesis below (L. Roberson)
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Jan 18, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Jan 13, 1911 to Jan 18, 1911
That I last saw him/her alive on (date): Jan 13, 1911
And that death occurred on the date stated above at (time AM/PM): 6 AM
THE CAUSE OF DEATH was as follows:
Cancer of Liver
(Duration)
Years:
Months: about 6
Days:
Signed (M.D.): C DeWeese
Date: Jan 18, 1911
Address: Fordsville, 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: Moorman Burial Ground
DATE OF BURIAL: Jan 19, 1911
19. UNDERTAKER: J.M. Craig
ADDRESS: Vanzant, Ky