1.       PLACE OF DEATH

County: Breckinridge    

Vot. Pol.: Rockvale

Inc Town:

City: ---

No. 

St.

Ward

Registration District No.: 134 or 137

Primary Registration District No: 5320

File No. 5644

Registered No:

2.       FULL NAME: Lillie Askins

PERSONAL AND STATICAL PARTICULARS

3.       SEX: Female    

4.       COLOR OR RACE: White

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED: Married

6.       DATE OF BIRTH: March 21, 1911

7.       AGE  (yr. mo. da) (If less than 1 day, hours or min?): 26 years 8 months 21 days

8.       OCCUPATION (a.) Trade, profession or particular kind of work: housekeeper

(b.)  General nature of industry business or establishment which employed: At Home

9.       BIRTHPLACE: Ohio Co., KY

10.   NAME OF FATHER: Charles W. Carter

11.   BIRTHPLACE OF FATHER: Ohio Co., KY

12.   MAIDEN NAME OF MOTHER: E.J. Boiles

13.   BIRTHPLACE OF MOTHER: Houdcock Co., KY

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Isom Askins

(Address)Rockvale, KY

15.   Filed Mar 21, 1911

REGISTAR: E.L. Robertson

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH: March 21, 1911

17.   I HEREBY CERTIFY, That I attended deceased from (date): March 19, 1911

That I last saw him/her alive on (date): March 20, 1911

And that death occurred on the date stated above at (time AM/PM): 7 am

THE CAUSE OF DEATH was as follows: Puerpual Ealeunpaid (Enemic)

 (Duration)

Years:

Months:

Days:

Signed (M.D.): R.L. Dumpaten

Date: March 21, 1911

Address: Gl---------, 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: Union Chapel

DATE OF BURIAL: 3-22-1911

20.   UNDERTAKER: Isom Askins

ADDRESS: Rockvale, KY