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1.	PLACE OF DEATH
County: BRECKINRIDGE 
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  IRVINGTON
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  
Registered No: 5312 
2.	FULL NAME:  NOAH HICKS
PERSONAL AND STATICAL PARTICULARS
3.	SEX: MALE 
4.	COLOR OR RACE: WHITE 
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 
6.	DATE OF BIRTH: DEC 22, 1847 
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?): 65YRS 11MOS 4DS 
8.	OCCUPATION (a.) Trade, profession or particular kind of work: FARMER 
(b.)  General nature of industry business or establishment which employed: GENERAL FARM WORK 
9.	BIRTHPLACE: HARDIN CO, KY 
10.	NAME OF FATHER: GEO. E. HICKS 
11.	BIRTHPLACE OF FATHER: KENTUCKY 
12.	MAIDEN NAME OF MOTHER:  SUSAN HARTLEY
13.	BIRTHPLACE OF MOTHER:  KENTUCKY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JOHN H. HICKS
(Address) PORT ARTHUR, TEXAS 
15.	Filed  NOV 30, 1913
REGISTAR: D.W. HENRY 
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH: NOVEMBER 25, 1913 
17.	I HEREBY CERTIFY, That I attended deceased from (date): NOVEMBER 17TH, 1913 TO NOV 25, 1913 
That I last saw him alive on (date): NOV 25, 1913  
And that death occurred on the date stated above at (time AM/PM): 10 PM 
THE CAUSE OF DEATH was as follows:  
CEREBRAL APOPLEXY
(Duration)   Years:            Months:            Days: 8 
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S.P. PARKS
Date: NOV 26, 1913 
Address: IRVINGTON 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: VINE GROVE (HARDIN CO) 
DATE OF BURIAL:  NOV 26, 1913
20.	UNDERTAKER:  JIM HARNED
ADDRESS:  VINE GROVE, KY


ADDITIONAL COMMENTS/NOTES:

He is buried at Forks of Otter Creek Cemetery, Vine Grove, Hardin Co, KY.
(Burial information courtesy of Jen Ritchie, Breck. Co. Transcriber) 



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