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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CLOVERPORT
Inc Town:  
City:  
No.  
St.  
Ward:  2nd
Registration District No.:  5306
Primary Registration District No:  
File No.  6362
Registered No:  102
2.	FULL NAME:  SATERFIELD, MARY JESSIE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE	
4.	COLOR OR RACE:  BLACK
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  OCT 1, 1894
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  18 / 5 / 3
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  GENERAL COOKING
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUCKY
10.	NAME OF FATHER:  HENRY SATERFIELD
11.	BIRTHPLACE OF FATHER:  KENTUCKY
12.	MAIDEN NAME OF MOTHER:  MOLIE LASLIE
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  NANNIE SATERFIELD
(Address)  CLOVERPORT
15.	Filed MAR 5, 1913 
REGISTAR:  J.C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAR 3, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  DEC 15, 1912 to MAR 3, 1913
That I last saw him/her alive on (date):  MAR 2, 1913
And that death occurred on the date stated above at (time AM/PM):  8 PM
THE CAUSE OF DEATH was as follows:  PULMONARY TUBERCULOSIS
(Duration)   Years:            Months:    6        Days:    
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.L. LIGHTFOOT
Date:  MAR 5, 1913
Address:  CLOVERPORT
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:  COLORED CEMETERY
DATE OF BURIAL:  FEB 5, 1913   [DATE DEFINATELY IN ERROR]
20.	UNDERTAKER:  M. HAMMAN & SONS
ADDRESS:  CLOVERPORT


ADDITIONAL COMMENTS/NOTES:




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