1. PLACE OF DEATH
County:  Breckinridge, Co.
Vot. Pol.:  Glen Dean Ky
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  132
Primary Registration District No:  5317
File No.  2926
Registered No:  
2. FULL NAME:  Mary E. Whittinghill
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Jan. 14, 1860
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  52 yrs  13 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  House keeper
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hancock Co., Ky
10. NAME OF FATHER:  Not known
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Susan Ra
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  B. A. Whittinghill
(Address)  
15. Filed  Jan. 20, 1912
REGISTAR:  E. L. Robertson
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Jan. 27, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Feb. 14, 1904 to Jan. 27, 1912
That I last saw him/her alive on (date):  Jan. 27, 1912
And that death occurred on the date stated above at (time AM/PM):  2 p.m.
THE CAUSE OF DEATH was as follows:  Tubercolisis

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  P. E. Dempster, M.D.
Date:  Jan. 29, 1912
Address:  Glen Dean, 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:  Lewisport, Ky
DATE OF BURIAL:  Jan. 29, 1912
20. UNDERTAKER:  Dennis Walker
ADDRESS:  Fordsville