1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  
File No.  2954
Registered No:  14
2. FULL NAME:  Calla Jane Tabor
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  Black
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  single
6. DATE OF BIRTH:  June 14, 1893
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  17 yrs  8 mos  3 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Handy girl
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co., Ky
10. NAME OF FATHER:  Jordon Tabor
11. BIRTHPLACE OF FATHER:  Breckinridge Co., Ky
12. MAIDEN NAME OF MOTHER:  Della Scott
13. BIRTHPLACE OF MOTHER:  Breckinridge Co., Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Wm. Dean
(Address)  Hardinsburg, Ky
15. Filed  Feb 19, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  February 17, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Nov. 17, 1910 to Feb. 17, 1911
That I last saw him/her alive on (date):  Feb. 16, 1911
And that death occurred on the date stated above at (time AM/PM):  
THE CAUSE OF DEATH was as follows:  Pulmanory Tuberculosis

(Duration)   Years:            Months:   3         Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. M. Kincheloe, M. D.
Date:  2-18, 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:  Colored Cemetery
DATE OF BURIAL:  Feb. 18, 1911
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg, Ky
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