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1. PLACE OF DEATH
County:  Breckinridge, Ky
Vot. Pol.:  Webster
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5311
Primary Registration District No:  
File No.  6239
Registered No:  
2. FULL NAME:  Martha Parsons
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  June, 1828
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  86 years, 8 months
8. OCCUPATION (a.) Trade, profession or particular kind of work:  house work
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckenridge Co., Ky
10. NAME OF FATHER:  not known
11. BIRTHPLACE OF FATHER:  not known
12. MAIDEN NAME OF MOTHER:  not known
13. BIRTHPLACE OF MOTHER:  not known
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  L. H. Bashman
(Address)  Clifton Mills
15. Filed  3/9, 1914
REGISTAR:  H. Drane
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  March 1st, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  twice Jan to Feb. 14, 1914
That I last saw him/her alive on (date):  Feb 15, 1914
And that death occurred on the date stated above at (time AM/PM):  7 AM
THE CAUSE OF DEATH was as follows:  old age, starvation and Heart Failure
 
(Duration)   Years:            Months:            Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  H. B. Kurtz
Date:  March 1, 1914
Address:  Clifton Mills
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:  
DATE OF BURIAL:  3/3, 1914
20. UNDERTAKER:  
ADDRESS:  
 

ADDITIONAL COMMENTS/NOTES:
 
There is no further information in either of the Breckinridge County Cemetery books.
 

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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