1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  5307
Inc Town:  Cloverport, 2065
City:  
No.  
St.  
Ward:  3rd 
Registration District No.:  5307
Primary Registration District No:  131
File No.  20129
Registered No:  36
2. FULL NAME:  Minnie Belle Snyder
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  June 15, 1890
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  21 yrs  2 mos  12 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Telephone Operator
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Illinois
10. NAME OF FATHER:  John Snyder
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Mary L. Grant
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mary L. Embry
(Address)  Cloverport, Ky
15. Filed  Aug 28, 1911
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Aug. 27, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 1st, 1911 to Aug. 27th, 1911
That I last saw him/her alive on (date):  Aug. 27th, 1911
And that death occurred on the date stated above at (time AM/PM):  11:20 a.m.
THE CAUSE OF DEATH was as follows:  Pulmonary Tuberculosis

(Duration)   Years:            Months:   4         Days:  27
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C. R. Lightfoot, M.D.
Date:  Aug. 28th, 1911
Address:  Cloverport, Ky
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:  Cloverport, Ky
DATE OF BURIAL:  Aug. 28, 1911
20. UNDERTAKER:  M. Hamman & Son
ADDRESS:  Cloverport, Ky
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