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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  ROCK VALE
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5320
Primary Registration District No:  
File No.  8515
Registered No:  5320
2.	FULL NAME:  SWIHART, NANCY JACKSON
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  MAY 24, 1851
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  56 / 5 / 24
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  HANCOCK COUNTY
10.	NAME OF FATHER:  JACKSON
11.	BIRTHPLACE OF FATHER:  NOT KNOWN
12.	MAIDEN NAME OF MOTHER:  NOT KNOWN
13.	BIRTHPLACE OF MOTHER:  NOT KNOWN
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  G.W. SWIHART
(Address)  VAN ZANDT RR #1
15.	Filed  FEB 26, 1914
REGISTAR:  J.D. McDONOUGH
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  FEB 19, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NEVER SAW HER - ONLY PRESCRIBED AS DIRECTED
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  3 PM
THE CAUSE OF DEATH was as follows:  CASE OF CHANGE OF LIFE
(Duration)   Years:            Months:            Days:    
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.): W.B. HEDDEN 
Date:  FEB 19, 1914
Address:  FORDSVILLE
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:  PLEASANT GROVE
DATE OF BURIAL:  FEB 21, 1914
20.	UNDERTAKER:  T.E. BUTLER
ADDRESS:  FORDSVILLE


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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