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.  24214
Registered No:  124
2. FULL NAME:  Henry Wish
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  April  26, 1836
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  76 yrs  5 mos  12 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  At home
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Kentucky
10. NAME OF FATHER:  Brausin Wish
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Alsie Woods
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Irvin Blair
(Address)  Hardinsburg
15. Filed  Oct. 9, 1912
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Oct 8, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Oct 1, 1912 to Oct 8, 1912
That I last saw him/her alive on (date):  Oct 1st, 1912
And that death occurred on the date stated above at (time AM/PM):  4 m.
THE CAUSE OF DEATH was as follows:  Arterio Scherosis

(Duration)   Years:  4          Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Jno. E. Kincheloe, M.D.
Date:  Oct 8, 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:  Jolly Cemetery
DATE OF BURIAL:  Oct. 9, 1912
20. UNDERTAKER:  B. F. Beard & Co.
ADDRESS:  Hardinsburg, Ky