1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  1
Registration District No.:  130
Primary Registration District No:  5301
File No.  3313
Registered No:  
2. FULL NAME:  Vandergraft, Mary
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Jan 6 1891
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  21 yr 1 mo 21 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER :  Athel Anderson
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Mary Thomas
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mrs. Mary Brown
(Address)  Hardinsburg, KY
15. Filed  Mar 7, 1912
REGISTRAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Feb 27 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb 1 1912
That I last saw him/her alive on (date):  Feb 27 1912
And that death occurred on the date stated above at time AM/PM):  
THE CAUSE OF DEATH was as follows:  Pulmonary tuberculosis

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

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  John E. Kincheloe
Date:  Mar 7 1912
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:  Owen Cemetery
DATE OF BURIAL:  Feb 28 1912
20. UNDERTAKER:  Pete Sheeran
ADDRESS:  Kirk, KY

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