1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CUSTER
Inc Town:  -
City:  -
No. 
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  
File No.  2961
Registered No:  7
2. FULL NAME:  FONZY BENNETT
PERSONAL AND STATICAL PARTICULARS
3. SEX:  FEMALE
4. COLOR OR RACE:  WHITE	
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6. DATE OF BIRTH:  APRIL 19, 1878
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  32 / 11 / 11 
8. OCCUPATION (a.) Trade, profession or particular kind of work:  HOUSEKEEPER
(b.)  General nature of industry business or establishment which employed:  -
9. BIRTHPLACE:  BIG SPRING
10. NAME OF FATHER:  DICK SIPES
11. BIRTHPLACE OF FATHER:  HARDIN COUNTY
12. MAIDEN NAME OF MOTHER:  LIZZIE KASEY
13. BIRTHPLACE OF MOTHER:  ROSETTA
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  AMERICUS SMITH
(Address)  CUSTER, KY.
15. Filed  MCH 1, 1911
REGISTAR:  R.O. PENICK
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  FEB. 28, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  FEB 1909 TO FEB 28, 1911
That I last saw him/her alive on (date):  FEB. 28, 1911
And that death occurred on the date stated above at (time AM/PM):  5 P.M.
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS

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

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  R.W. & J. W. MEADOR
Date:  MAR 1, 1911
Address:  CUSTER
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:  KASEY GR.  (ILLEGIBLE LETTER) D
DATE OF BURIAL:  MCH 1, 1911
20. UNDERTAKER:  R. O. PENICK  SOLD CASKET DID NOT ATTEND PERSONALLY
ADDRESS:  CUSTER, KY