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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hudson
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  
Primary Registration District No:  5316
File No.  [blanked out, following number written in above the line] 33679
Registered No:  7
2. FULL NAME:  Thomas LeGrand
PERSONAL AND STATICAL PARTICULARS
3. SEX:  male
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed
6. DATE OF BIRTH:  3 - 26 - 1834
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  79 years, 7 months, 26 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Ky
10. NAME OF FATHER:  Geo. C. LeGrand
11. BIRTHPLACE OF FATHER:  Ky
12. MAIDEN NAME OF MOTHER:  Mercey Bridwell
13. BIRTHPLACE OF MOTHER:  Ky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Mace LeGrand
(Address)  Hudson, Ky
15. Filed  11 - 24 - 1913
REGISTAR:  J. H. Comer
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  11 - 23 - 1913
17. I HEREBY CERTIFY, That I attended deceased from (date):  Nov 22 to Nov 23, 1913
That I last saw him/her alive on (date):  Nov. 22, 1913
And that death occurred on the date stated above at (time AM/PM):  [blank]
THE CAUSE OF DEATH was as follows:  Cancer of the face & Trachea
 
(Duration)   Years:     1       Months:            Days:  
Contributory:  
 
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S. J. Hall
Date:  11 -24 - 1913
Address:  Constantine
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:  Le Grand Cemetery
DATE OF BURIAL:  Nov. 24, 1913
20. UNDERTAKER:  E. A. Stone
ADDRESS:  Hardin Springs, Ky
 

ADDITIONAL COMMENTS/NOTES:
 
 
 

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