1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  2
Registration District No.:  5302
Primary Registration District No:  130
File No.  22673
Registered No:  59
2. FULL NAME:  Mrs. Minnie Taylor
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  July 25, 1885
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  26 yrs  2 mos  3 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House Keeper
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Sam Muse
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Mollie Prather
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  O. E. Floyd
(Address)  Kingswood, Ky
15. Filed  Sept 19, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Sept. 29, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Sept. 14, 1911 to Sept. 29, 1911
That I last saw him/her alive on (date):  Sept. 29, 1911
And that death occurred on the date stated above at (time AM/PM):  12:43 p.m.
THE CAUSE OF DEATH was as follows:  Exophthalmic Goiter

(Duration)   Years:  2          Months:  6          Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. E. Matthews, M.D.
Date:  Sept. 29, 1911
Address:  Westview, 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:  Van Hoosie Cemetery
DATE OF BURIAL:  Sept. 30, 1911
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg, Ky

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