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1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg
Inc Town:
City:
No.
St.
Ward
Registration District No.: 130
Primary Registration District No: 5303
File No.17184
Registered No: 43
1. FULL NAME: Tater Dukes
PERSONAL AND STATICAL PARTICULARS
2. SEX: Male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: July 30, 1910
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 11mos20ds
7. OCCUPATION (a.) Trade, profession or particular kind of work:
(b.)  General nature of industry business or establishment which employed: at home
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: Vol Dukes
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Sallie Emery
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) JW Jarboe
(Address) Hardinsburg, Ky
14. Filed July 11, 1911
REGISTAR: H.B. Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: July 10, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Jan 3, 1911 to July 10, 1911
That I last saw him/her alive on (date): Jan 3, 1911
And that death occurred on the date stated above at (time AM/PM): 1 AM
THE CAUSE OF DEATH was as follows:
Epilepsy
(Duration)
Years:
Months:
Days:
Signed (M.D.): Jno. E. Kincheloe
Date: July 11, 1911
Address: Hardinsburg, Ky
17. 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:
18. PLACE OF BURIAL OR REMOVAL: Robards Cemetery
DATE OF BURIAL: July 10, 1911
19. UNDERTAKER: B.F. Beard & Co
ADDRESS: Hardinsburg







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Copyright.  All rights reserved.
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