1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  3
Registration District No.:  130
Primary Registration District No:  5305
File No.  27662
Registered No:  69
2. FULL NAME:  Stella Stilwell
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  Apr. 3, 1906
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  5 yrs  7 mos  21ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  At home
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Cal Stilwell
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Minnie Sturgeon
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Lucke Dowell
(Address)  Sample, Ky
15. Filed  Nov. 24, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Nov. 24, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Nov. 6, 1911 to Nov. 24, 1911
That I last saw him/her alive on (date):  Nov. 20, 1911
And that death occurred on the date stated above at (time AM/PM):  4 a.m.
THE CAUSE OF DEATH was as follows:  Mastoid Abscess

(Duration)   Years:            Months:            Days:  18
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Jno  E. Kincheloe, M.D.
Date:  Nov. 24, 1911
Address:  Hardinsburg, 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:  ??????? Cemetery
DATE OF BURIAL:  Nov. 24, 1911
20. UNDERTAKER:  B. F. Beard & Co.
ADDRESS:  Hardinsburg, Ky

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