1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg
Inc Town:
City: Hardinsburg, Ky
No.
St.
Ward: 2
Registration District No.: 130
Primary Registration District No: 5302
File No. 9226
Registered No: 89
1. FULL NAME: Phoebe A Skillman
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: widowed
5. DATE OF BIRTH: 8/19/1841
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 70yrs7mos17ds
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: Rodrick Warfield
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Martha Haynes
12. BIRTHPLACE OF MOTHER: Hardin Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Abram Skillman
(Address) Hardinsburg, Ky
14. Filed Apr 7, 1912
REGISTAR: WB Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: April 6, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Jan 2, 1912 to April 6, 1912
That I last saw him/her alive on (date): April 6, 1912
And that death occurred on the date stated above at (time AM/PM): 10 PM
THE CAUSE OF DEATH was as follows:
Chronic Nephritis
(Duration)
Years:
Months:
Days:
Contributory: Uremia…….3days
Signed (M.D.):AM Kincheloe
Date: 4-7-1912
Address: Hardinsburg, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Skillman Cemetery
DATE OF BURIAL: Apr 7, 1912
19. UNDERTAKER: BF Beard & Co
ADDRESS: Hardinsburg, Ky