1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Union Star
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5309
File No.  16549
Registered No:  10
2. FULL NAME:  Elizabeth Tabor West
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  April 16, 1829
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  83 yrs  3  mos  1 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Had done nothing for years.
(b.)  General nature of industry business or establishment which employed:  Last work was general house work
9. BIRTHPLACE:  Breckinridge Co., Ky
10. NAME OF FATHER:  Philip Tabler
11. BIRTHPLACE OF FATHER:  Va
12. MAIDEN NAME OF MOTHER:  Susan Compton
13. BIRTHPLACE OF MOTHER:  Va
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Jacob Carl
(Address)  Union Star
15. Filed  7/19, 1912
REGISTAR:  Lee Stewart
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  July 17, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  May 2, 1912 to May 2, 1912
That I last saw him/her alive on (date):  May 2, 1912
And that death occurred on the date stated above at (time AM/PM):  2 a.m.
THE CAUSE OF DEATH was as follows:  When I saw her she was suffering from a broken hip bone

(Duration)   Years:            Months:  2          Days:  15
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Wm. L. Milner, M.D.
Date:  7/17, 1912
Address:  Union Star
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:  Walnut Grove
DATE OF BURIAL:  July 18, 1912
20. UNDERTAKER:  G. T. Marshall & Son
ADDRESS:  Irvington, Ky