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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.:  5307
Inc Town:  
City: CLOVERPORT  
No.  
St.  
Ward: 3
Registration District No.:  131
Primary Registration District No:  2065
File No.  22919
Registered No: 167 
2.	FULL NAME:  STEWART, HATTIE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  BLACK
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  NOV 1875
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  38 YR 10 MO
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  CLOVERPORT, KY
10.	NAME OF FATHER:  ALFRED BRIDWELL
11.	BIRTHPLACE OF FATHER:  BRECKINRIDGE  CO., KY
12.	MAIDEN NAME OF MOTHER:  MARTHA HAMBLETON
13.	BIRTHPLACE OF MOTHER:  BRECKINRIDGE CO., KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  THOMAS STEWART
(Address)  CLOVERPORT, KY
15.	Filed  SEPT 5, 1914
REGISTRAR:  J. C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: SEPT. 5, 1914 
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV. 1, 1913
That I last saw him/her alive on (date):  SEPT. 4, 1914
And that death occurred on the date stated above at (time AM/PM):  4-5 AM
THE CAUSE OF DEATH was as follows:  PHTHISIS PULMONALIA

(Duration)   Years:     1       Months:           Days:  
Contributory:  HEREDITARY AND EXPOSURE

(Duration)   Years:     3       Months:            Days:  
Signed (M.D.):  O. R. LIGHTFOOT
Date:  SEPT. 5, 1914
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:  LOCUST HILL, CLOVERPORT, KY
DATE OF BURIAL:  SEPT 6, 1914
20.	UNDERTAKER:  M. HAMMAN 
ADDRESS:  CLOVERPORT, KY

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