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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.:  5306
Inc Town:  
City:  CLOVERPORT, KY
No.  
St.  
Ward:  2
Registration District No.:  131
Primary Registration District No:  2065
File No.  31412
Registered No:  132
2.	FULL NAME:  SWAREUS, EMMA J.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  FEB 10, 1849
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  64 YR 9 MO 26 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KY
10.	NAME OF FATHER:  DAVID DUKE
11.	BIRTHPLACE OF FATHER:  KY
12.	MAIDEN NAME OF MOTHER:  SARAH KING
13.	BIRTHPLACE OF MOTHER:  NEW YORK
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  DAVID H. SWAREUS
(Address)  CLOVERPORT, KY
15.	Filed  DEC 6, 1913
REGISTRAR:  J. C. NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: DEC 6, 1913 
17.	I HEREBY CERTIFY, That I attended deceased from (date):  APR 1913
That I last saw him/her alive on (date):  DEC 1, 1913
And that death occurred on the date stated above at (time AM/PM):  7:30 AM
THE CAUSE OF DEATH was as follows:  ARTERIO-SCLEROSIS (GENERAL)

(Duration)   Years:            Months:           Days:  
Contributory:  CHRONIC VALVULAR HEART DISEASE

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. H. SIMONS
Date:  DEC 6, 1913
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:  DEC 8, 1913
20.	UNDERTAKER:  M. HAMMON SONS
ADDRESS:  CLOVERPORT, KY


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