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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg
Inc Town:
City:
No.
St.
Ward
Registration District No.: 130 
Primary Registration District No: 5303
File No. 17186
Registered No: 46
1. FULL NAME: Nancy Richardson
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white 
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: 1/14/1884
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 27yrs6mos1d
7. OCCUPATION (a.) Trade, profession or particular kind of work: housekeeping
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER:  James W Tabor
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Nancy French
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Mr. Richard McCoy
(Address) Garfield, Ky
14. Filed July 16, 1911
REGISTAR: W.B. Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: July 15, 1911 
16. I HEREBY CERTIFY, That I attended deceased from (date): May 1911 to July 15, 1911
That I last saw him/her alive on (date): seven weeks ago, 1911
And that death occurred on the date stated above at (time AM/PM): 3PM
THE CAUSE OF DEATH was as follows:
Pulmonary Consumption contracted <  > in Texas  <  > two years ago
(Duration)
Years:
Months:
Days:
Signed (M.D.): AW Kincheloe
Date: July 15, 1911
Address: Hardinsburg, Ky
17. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.): 2 ½ mos 
In the State (yr, mo, da): 2 ½ mos
Where was disease contracted,  if not at place of death? Texas
Former or usual residence: Kentucky
18. PLACE OF BURIAL OR REMOVAL: Garfield Cem
DATE OF BURIAL: July 16, 1911
19. UNDERTAKER: I.B. Richardson
ADDRESS: Garfield, Ky

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Copyright.  All rights reserved.
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