1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Rockvale
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  132
File No.  22375
Registered No:  
2. FULL NAME:  Biven Swift
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  July 31, 1911
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  5 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., Ky
10. NAME OF FATHER:  Wain Swift
11. BIRTHPLACE OF FATHER:  Butler Co., Ky
12. MAIDEN NAME OF MOTHER:  Martha Bryant
13. BIRTHPLACE OF MOTHER:  Butler Co., Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Wain Swift
(Address)  Rockvale, Ky
15. Filed  Aug 6, 1911
REGISTAR:  E. L. Robertson
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Aug. 5, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Aug. 5, 1911 to Aug. 5, 1911
That I last saw him/her alive on (date):  Aug. 5, 1911
And that death occurred on the date stated above at (time AM/PM):  8 p.m.
THE CAUSE OF DEATH was as follows:  Convulsions following acute nephritis

(Duration)   Years:            Months:            Days:  1
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R. T. Dempster, M.D.
Date:  Aug. 6, 1911
Address:  Glen Dean
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:  Robertson Bur. Gd.
DATE OF BURIAL:  Aug. 6, 1911
20. UNDERTAKER:  Not known
ADDRESS:  
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