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1.	PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  Custer
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  15
File No.  33678
Registered No:  61
2.	FULL NAME:  Alcie Bell Dunn
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  Female
4.	COLOR OR RACE:  White
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  
6.	DATE OF BIRTH:  January 22, 1882
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  31 yrs, 10 mos, 24 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:  Breckenridge Co Ky
10.	NAME OF FATHER:  Joel Meador
11.	BIRTHPLACE OF FATHER:  Breckenridge Co Ky
12.	MAIDEN NAME OF MOTHER:  Sallie Basham
13.	BIRTHPLACE OF MOTHER:  Breckenridge Co Ky
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Louis Dunn
(Address)  Custer
15.	Filed:  Nov 16, 1913  
REGISTAR:  J. T. Mitcham
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  November 16, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  Nov 3, 1913 to Nov 15, 1913
That I last saw her alive on (date):  Nov 15, 1913
And that death occurred on the date stated above at (time AM/PM):  Pneumonia
THE CAUSE OF DEATH was as follows:  

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. W. Meador
Date:  Nov 16, 1913
Address:  Custer, 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:  Basham B.ls
DATE OF BURIAL:  Nov 17, 1913
20.	UNDERTAKER:  Alf Taylor
ADDRESS:  Custer, Ky


ADDITIONAL COMMENTS/NOTES:




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