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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1.       PLACE OF DEATH

County:  Breckinridge

Vot. Pol.:  Big Spring

Inc Town:  Near Big Spring, Ky

City:  

No.  

St.  

Ward:  

Registration District No.:  5314

Primary Registration District No:  14

File No.  24220

Registered No:  9

2.       FULL NAME:  William Alther Lockard

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  male

4.       COLOR OR RACE:  white

5.       SINGLE, MARRIED, WIDOWED, OR DIVORCED:  widowed

6.       DATE OF BIRTH:  April 20, 1875

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  37 years, 5 months, 13 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:  Ferda Lockard

11.   BIRTHPLACE OF FATHER:  Ky

12.   MAIDEN NAME OF MOTHER:  Bittie Jordon

13.   BIRTHPLACE OF MOTHER:  Ky

14.   THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)  Losh Trent

(Address)  Custer, Ky

15.   Filed  Oct 7, 1912

REGISTAR:  J. D. Morris

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  October 3, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  Sept 25 to Oct 3, 1912

That I last saw him/her alive on (date):  Oct 3, 1912

And that death occurred on the date stated above at (time AM/PM):  6 pm

THE CAUSE OF DEATH was as follows:  Typhoid Fever

 

(Duration)   Years:            Months:            Days:  12

Contributory:  Pneumonia

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  R. W. Meador

Date:  Oct 4, 1912

Address:  Custer, 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:  Rozetta Cemetery

DATE OF BURIAL:  Oct 4, 1912

20.   UNDERTAKER:  Alf Taylor

ADDRESS:  Custer, Ky





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Copyright.  All rights reserved.
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