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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.:  Hudson

Inc Town:  

City:  

No.  

St.  

Ward:  

Registration District No.:  5316

Primary Registration District No:  

File No.  19031

Registered No:  12

2.       FULL NAME:  Lester R. Lucas

PERSONAL AND STATICAL PARTICULARS

3.       SEX:  female

4.       COLOR OR RACE:  white

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

6.       DATE OF BIRTH:  May 2, 1912

7.       AGE (yr. mo. da) (If less than 1 day, hours or min?):  3 months, 28 days

8.       OCCUPATION (a.) Trade, profession or particular kind of work:  Infant

(b.)  General nature of industry business or establishment which employed:  

9.       BIRTHPLACE:  Breckinridge County, Ky

10.   NAME OF FATHER:  John T. Lucas

11.   BIRTHPLACE OF FATHER:  Breckinridge Co., Ky

12.   MAIDEN NAME OF MOTHER:  Evaline Nellie

13.   BIRTHPLACE OF MOTHER:  Breckinridge Co., Ky

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

(Informant)  J. H. Davis

(Address)  Lucas Hill

15.   Filed  9/1, 1912

REGISTAR:  J.H. Comer

MEDICAL CERTIFICATE OF DEATH

16.   DATE OF DEATH:  August 31, 1912

17.   I HEREBY CERTIFY, That I attended deceased from (date):  July 20  to Aug. 30, 1912

That I last saw him/her alive on (date):  July 30, 1912

And that death occurred on the date stated above at (time AM/PM):  9 am

THE CAUSE OF DEATH was as follows:  Cholera Infantum

 

(Duration)   Years:            Months:            Days:  

Contributory:  

 

(Duration)   Years:            Months:            Days:  

Signed (M.D.):  J. W. Meador, MD

Date:  9/1, 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:  Pile Cemetery

DATE OF BURIAL:  9/1, 1912

20.   UNDERTAKER:  R. L. Givan

ADDRESS:  Constantine, Ky





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Copyright.  All rights reserved.
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