1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Custer
Inc Town:
City:
No.
St.
Ward
Registration District No.: 15
Primary Registration District No: 5315
File No. 19027
Registered No: 31
1. FULL NAME: Freedy Laslie
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: January 7, 1912
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 7mos15ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: Infant
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co, Ky
9. NAME OF FATHER: John H Lasley
10. BIRTHPLACE OF FATHER: Breckinridge Co, Ky
11. MAIDEN NAME OF MOTHER: Josie Pile
12. BIRTHPLACE OF MOTHER: Breckinridge Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Iaac (Isaac) Pile Jr 
(Address) Custer, Ky
14. Filed Aug 24, 1912
REGISTAR: R.O. Penick
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: August 23, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): August 22, 1912
That I last saw him/her alive on (date): August 22, 1912
And that death occurred on the date stated above at (time AM/PM): 1AM
THE CAUSE OF DEATH was as follows:
Cholera Infantum
(Duration)
Years:
Months:
Days: 1
Signed (M.D.): JW Meador
Date: Aug 23, 1912
Address: Custer, 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: Pile Grave Yard
DATE OF BURIAL: Aug 24, 1912
19. UNDERTAKER: H.H. Harkinson
ADDRESS: Custer, Ky