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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  8
Inc Town:  STEPHENSPORT
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  15011
Registered No: 41 
2.	FULL NAME:  PIERCE, NANCY SMITH
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6.	DATE OF BIRTH:  1858
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  FARMING
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  HARDIN COUNTY
10.	NAME OF FATHER:  HENRY SMITH
11.	BIRTHPLACE OF FATHER:  HARDIN COUNTY
12.	MAIDEN NAME OF MOTHER:  DICIE A. SMITH
13.	BIRTHPLACE OF MOTHER:  HARDIN COUNTY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J.M. MARSHALL [DIFFICULT TO READ]
(Address)  STEPHENSPORT
15.	Filed  JUN 25, 1913
REGISTAR:  R.A. SHALLMAN
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  JUN 28, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  JUL 1912 to NOV 1912 [DATES CORRECT]
That I last saw him/her alive on (date):  NOV 12, 1912
And that death occurred on the date stated above at (time AM/PM):  1 AM
THE CAUSE OF DEATH was as follows:  CHRONIC DYSENTERY
(Duration)   Years:     2       Months:            Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  GEORGE E. SHIVELEY
Date:  JUL 28, 1913
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:  near ADDISON, KY
DATE OF BURIAL:  JUN 28, 1913
20.	UNDERTAKER:  W.J. SCHOPP
ADDRESS:  STEPHENSPORT


ADDITIONAL COMMENTS/NOTES:




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