1. PLACE OF DEATH County: BRECKINRIDGE Vot. Pol.: HUDSON, KY. Inc Town: City: No. St. Ward: Registration District No.: 5316 Primary Registration District No: File No. 27669 Registered No: 18 2. FULL NAME: LUELLA BENNETT PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: FEB. 28, 1862 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 49 / 9 / 28 8. OCCUPATION (a.) Trade, profession or particular kind of work: HOUSEWORK (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: WILLIAM LYON 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: SCOTT 13. BIRTHPLACE OF MOTHER: UNKNOWN 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) ANDREW LYON (Address) CUSTER 15. Filed 11-28, 1911 REGISTAR: J. H. COMER MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: NOV. 26, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): MAY 15, 1910 TO NOV. 25, 1911 That I last saw him/her alive on (date): NOV. 25, 1911 And that death occurred on the date stated above at (time AM/PM): - THE CAUSE OF DEATH was as follows: PARALSIS (Duration) Years: Months: Days: 1 Contributory: NEURITIS (Duration) Years: 2 Months: 6 Days: 11 Signed (M.D.): S. J. HALL Date: 11-27, 1911 Address: CONSTNTINE 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: LYONS GRAVE YARD DATE OF BURIAL: NOV. 27, 1911 20. UNDERTAKER: PETE BENNETT ADDRESS: HUDSON, KY.