1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Custer Ky
Inc Town:
City:
No.
St.
Ward
Registration District No.:
Primary Registration District No: 5315
File No. 29819
Registered No: 38
1. FULL NAME: Ada M Thornhill
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: Dec 24, 1882
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 29yrs11mos15ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: house keeper
(b.)  General nature of industry business or establishment which employed: house work
8. BIRTHPLACE: Garfield, Breckinridge Co, Ky
9. NAME OF FATHER: Sam Priest
10. BIRTHPLACE OF FATHER: Garfield, Breck Co, Ky
11. MAIDEN NAME OF MOTHER: Mary Ann Compton
12. BIRTHPLACE OF MOTHER: Garfield, Breck Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Earnest Davis 
(Address) Locust Hill Ky
14. Filed Dec 17, 1912
REGISTAR: J.T. Mitcham
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Dec 15, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): Mar 30, 1912 to Dec 15. 1912
That I last saw him/her alive on (date): Dec 14, 1912
And that death occurred on the date stated above at (time AM/PM): 11AM
THE CAUSE OF DEATH was as follows:
Pelvic Peritonitis followed by Abscess
(Duration)
Years:
Months:
Days: 16
Contributory: abscess in <  > of fallopian tube
Signed (M.D.): JA Sandbach
Date: Dec 15, 1912
Address: Garfield, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Garfield, Ky
DATE OF BURIAL: Dec 16, 1912
19. UNDERTAKER: I.B. Richardson
ADDRESS: Garfield, Ky

************************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ky/kyfiles.html
************************************************************************
************************************************************************

File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

************************************************************************