************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************ 1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Custer Inc Town: Custer City: No. St. Ward: Registration District No.: 5315 Primary Registration District No: File No. 264 Registered No: 3 2. FULL NAME: Lucas, Albert PERSONAL AND STATICAL PARTICULARS 3. SEX: male 4. COLOR OR RACE: white 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single 6. DATE OF BIRTH: May 29, 1910 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 7 mos 26 ds. 8. OCCUPATION (a.) Trade, profession or particular kind of work: Infant (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: IL 10. NAME OF FATHER: Bill Lucas 11. BIRTHPLACE OF FATHER: Hudson 12. MAIDEN NAME OF MOTHER: Maggie Powell 13. BIRTHPLACE OF MOTHER: Custer 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) Geo Powell (Address) Custer 15. Filed Jan. 25, 1911 REGISTAR: R. O. Penick MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: Jan. 24, 1911 17. I HEREBY CERTIFY, That I attended deceased from (date): Jan 19, 1911 to Jan. 23, 1911 That I last saw him/her alive on (date): Jan. 23, 1911 And that death occurred on the date stated above at (time AM/PM): 3 A.M. THE CAUSE OF DEATH was as follows: Pneumonia (Duration) Years: Months: Days: 5 Contributory: (Duration) Years: Months: Days: Signed (M.D.): R. W. Meador Date: Jan. 28, 1911 Address: Custer 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: Good Hope DATE OF BURIAL: Jan. 25, 1911 20. UNDERTAKER: R. O. Penick ADDRESS: Custer, KY ************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************