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1. PLACE OF DEATH
County:  Breckenridge
Vot. Pol.:  5305
Inc Town:  Cloverport
City:  
No.  
St.  
Ward:  1st 
Registration District No.:  131
Primary Registration District No:  2065
File No.  31411
Registered No:  131
2. FULL NAME:  Lucinda (Simons) Gregory
PERSONAL AND STATICAL PARTICULARS
3. SEX:  female
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  June 30, 1845
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  68 years, 5 months, 2 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  At Home
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Tobin Township, Perry County, Indiana
10. NAME OF FATHER:  Arad S. Simons
11. BIRTHPLACE OF FATHER:  Louisville, Ky
12. MAIDEN NAME OF MOTHER:  Eliza Tate
13. BIRTHPLACE OF MOTHER:  Breckenridge Co., Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  A. A. Simons
(Address)  Cloverport, Ky
15. Filed  Dec 3, 1913
REGISTAR:  I. L. Nalts
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Dec 2, 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  March 1910 to Dec 2, 1913
That I last saw him/her alive on (date):  Dec 2, 1913
And that death occurred on the date stated above at (time AM/PM):  8:55 PM
THE CAUSE OF DEATH was as follows:  Pulmonary Tuberculosis
 
(Duration)   Years:   about 3 years         Months:            Days:  
Contributory:  Tubercular Intestinal Infection
 
(Duration)   Years:     2       Months:            Days:  
Signed (M.D.):  A. A. Simons
Date:  Dec 3, 1913
Address:  Cloverport, 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:  Cloverport, KY
DATE OF BURIAL:  Dec 4, 1913
20. UNDERTAKER:  M. Hammon & Son
ADDRESS:  Cloverport, Ky
 

ADDITIONAL COMMENTS/NOTES: Lucinda Gregory, w/o L. G.,  is buried in Cloverport Cemetery #1. 
From Breckenridge Cemetery Book, Volume 1, page 180. L. G. is also buried there.
 
 
 

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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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