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

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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  5306
Inc Town:  
City:  CLOVERPORT
No.  
St.  
Ward:
Registration District No.:  131
Primary Registration District No:  
File No.  25206
Registered No:  170
2.	FULL NAME:  WEATHERHOLT, HESTER
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  AUG 16 1863
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  51 YR 1 MO 18 DA
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  INDIANA
10.	NAME OF FATHER:  CHARLES ADAMS
11.	BIRTHPLACE OF FATHER:  INDIANA
12.	MAIDEN NAME OF MOTHER:  MATTIE STOUT
13.	BIRTHPLACE OF MOTHER:  INDIANA
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JAKE WEATHERHOLT
(Address)  CLOVERPORT, KY
15.	Filed  OCT 4, 1914
REGISTRAR:  J C NOLTE
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  OCT 4, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  OCT 1, 1912
That I last saw him/her alive on (date):  AUG 5, 1914
And that death occurred on the date stated above at (time AM/PM):  12:30 AM
THE CAUSE OF DEATH was as follows:  CANCER OF BREAST

(Duration)   Years:            Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. T. OWEN
Date:  OCT 4, 1914
Address:  CLOVERPORT, 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:  CLOVERPORT, KY
DATE OF BURIAL:  OCT 4, 1914
20.	UNDERTAKER:  M. HAMMAN & SON
ADDRESS:  CLOVERPORT, KY


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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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