1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  3
Registration District No.:  130
Primary Registration District No:  5303
File No.  427
Registered No:  75
2. FULL NAME:  Thomas Jefferson Whitfield
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  April 3, 1831
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  81 yrs  9 mos  16 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Grayson County
10. NAME OF FATHER:  Robert Whitfield
11. BIRTHPLACE OF FATHER:  Grayson County
12. MAIDEN NAME OF MOTHER:  Betsy Shaw
13. BIRTHPLACE OF MOTHER:  Grayson County
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Angus Whitfill
(Address)  Hardinsburg, Ky
15. Filed  Jan 19, 1912
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  January 18, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Aug. 4, 1911 to Jan. 15, 1912
That I last saw him/her alive on (date):  Jan. 15, 1912
And that death occurred on the date stated above at (time AM/PM):  6 p.m.
THE CAUSE OF DEATH was as follows:  Senility

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  E. A. Lex, M.D.
Date:  1/19, 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:  St. Roumald Cem.
DATE OF BURIAL:  Jan. 19, 1912
20. UNDERTAKER:  B. F. Beard & Co.
ADDRESS:  Hardinsburg, Ky