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1. PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  HARDINSBURG
Inc Town:  
City:  
No.  
St.  
Ward: 2
Registration District No.:  130
Primary Registration District No:  5302
File No.  14864
Registered No:  
2. FULL NAME:  HAYES, ALEXANDER
PERSONAL AND STATICAL PARTICULARS
3. SEX:  MALE
4. COLOR OR RACE:  BLACK
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6. DATE OF BIRTH:  NEAR 67 YEARS OLD
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  NEAR 67 YR
8. OCCUPATION (a.) Trade, profession or particular kind of work:  PUBLIC WORK
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  TENNESSEE
10. NAME OF FATHER:  UNKNOWN
11. BIRTHPLACE OF FATHER:  UNKNOWN
12. MAIDEN NAME OF MOTHER:  UNKNOWN
13. BIRTHPLACE OF MOTHER:  UNKNOWN
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  CLARANCE W. BELT
(Address)  HARNED, KY
15. Filed  JUNE 15, 1914
REGISTRAR:  W. B. LENNON
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  JUNE 14, 1914
17. I HEREBY CERTIFY, That I attended deceased from (date):  1913
That I last saw him/her alive on (date):  SPRING 1914
And that death occurred on the date stated above at (time AM/PM):  4 PM
THE CAUSE OF DEATH was as follows:  TUBERCULOSIS, LUNG

(Duration)   Years: OVER 1            Months:           Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.): A. M. KINCHELOE  
Date:  JUNE 14, 1914
Address:  HARDINSBURG, 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:  SCOTT CEMETERY
DATE OF BURIAL:  JUNE 15, 1914
20. UNDERTAKER:  ROBT. WEATHERFORD
ADDRESS:  HARNED, KY