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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HUDSON
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5316
File No.  12274
Registered No: 5 
2.	FULL NAME:  PAUL, JEWELL
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  FEB 3, 1901
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  12 / 2 / 10
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUKCY
10.	NAME OF FATHER:  WILLIAM C. PAUL
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  NELIE CLARK
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JAMES G- - - - [HARD TO READ]
(Address)  HARDIN SPRINGS
15.	Filed  MAY 21, 1913
REGISTAR:  J.H. COOMER
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MARY 13, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  MAY 7, 1913 to MAY 13, 1913
That I last saw him/her alive on (date):  MAY 13, 1913
And that death occurred on the date stated above at (Time AM/PM):  8 PM
THE CAUSE OF DEATH was as follows:  MALARIAL FEVER
(Duration)   Years:            Months:            Days:    20
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.G. HALE
Date:  MAY 14, 1913
Address:  HARDIN SPRINGS
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:  MT. HEBRON, KY 
DATE OF BURIAL:  MAY 14, 1913
20.	UNDERTAKER:  OLIVER DRANE
ADDRESS:  - - - -, KY 


ADDITIONAL COMMENTS/NOTES:




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