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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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1.	PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Bewleyville
Inc Town:  Rosetta
City:  
No.  
St.  
Ward:  
Registration District No.:  5313
Primary Registration District No:  
File No.  20736
Registered No:  15
2.	FULL NAME:  Lowrey, Larison L. 
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  male
4.	COLOR OR RACE:  white
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married
6.	DATE OF BIRTH:  Mch 28, 1882  [NOTE:  Feb written in above Mch ]
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  29 yrs  5 mos  11 ds. 
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Grayson Co, KY
10.	NAME OF FATHER:  Edward Lowrey
11.	BIRTHPLACE OF FATHER:  Trumbull County, Ohio
12.	MAIDEN NAME OF MOTHER:  Sarah Reese
13.	BIRTHPLACE OF MOTHER:  Russel Co, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Chas. King
(Address)  Irvington, KY
15.	Filed  Aug. 11, 1911  
REGISTAR:  R. O. Penick crossed out.  John Compton written in underneath
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  Aug. 11, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  June 2, 1911 to July 28 1911
That I last saw him/her alive on (date):  July 28, 1911
And that death occurred on the date stated above at (time AM/PM):  2 p.m.
THE CAUSE OF DEATH was as follows:  
Tuberculosis lungs
(Duration)   Years:            Months:            Days:  
Contributory:  
Tuberculosis Bowels ??
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  Dr. J. W. Meador
Date:  
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:  Rosetta
DATE OF BURIAL:  Aug. 12, 1911
20.	UNDERTAKER:   R. O. Penick
ADDRESS:  Custer, KY

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