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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  UNION STAR
Inc Town:  
City:  
No.  
St.  
Ward:
Registration District No.:  
Primary Registration District No:  
File No.  12328
Registered No:  5 
2.	FULL NAME:  	STIFF, MARY ALLICE
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  DEC. 29, 1852
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  61 YR 4 MO 26 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KY
10.	NAME OF FATHER:  J. A. STIFF
11.	BIRTHPLACE OF FATHER:  VIRGINIA
12.	MAIDEN NAME OF MOTHER:  MARY A. CLAYCOMB
13.	BIRTHPLACE OF MOTHER:  KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J. D. STIFF
(Address)  UNION STAR, KY
15.	Filed  MAY 29, 1914
REGISTRAR:  LEE STEWART
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  MAY 25, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  APR. 26, 1914
That I last saw him/her alive on (date):  MAY 8, 1914
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS

(Duration)   Years:            Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  WILLIAM B. MILNER
Date:  MAY 26, 1914
Address:  UNION STAR
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:  BRUNER GRAVEYARD
DATE OF BURIAL:  MAY 26, 1914
20.	UNDERTAKER:  C. A. TIMINS
ADDRESS:  STEPHENSPORT



************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************