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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  #9
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5309
Primary Registration District No:  
File No.  30821
Registered No:  17
2.	FULL NAME:  NOBLE, EMELINE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  JUN 1831
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  83 / 6 / -
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  ELIJAH NOBLE
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  BRUNER
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  R.B. C____
(Address)  UNION STAR
15.	Filed  4 JAN 1915
REGISTAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  DEC 30, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEC 25, 1914 to DEC 28, 1914
That I last saw him/her alive on (date):  DEC 25, 1914
And that death occurred on the date stated above at (time AM/PM):  3 AM
THE CAUSE OF DEATH was as follows:  LA GRIPPE
(Duration)   Years:            Months:            Days:    5
Contributory:  AGE
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  GEO. E. SHIVELEY
Date:  JAN 4, 1915
Address:  STEPHENSPORT
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:  BRUNER BURYING GROUND
DATE OF BURIAL:  DEC 31, 1914
20.	UNDERTAKER:  D.S. RICHARDSON
ADDRESS:  UNION STAR


ADDITIONAL COMMENTS/NOTES:




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