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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.  11582
Registered No:  9
2.	FULL NAME:  Lucas, Sherman
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  male
4.	COLOR OR RACE:  white
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  child
6.	DATE OF BIRTH:  Nov. 12, 1909
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  7 yrs.  7 mos.  11 ds.  
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  Breckinridge County, KY
10.	NAME OF FATHER:  John Lucas
11.	BIRTHPLACE OF FATHER:  Grayson County, KY
12.	MAIDEN NAME OF MOTHER:  Lula Dupin
13.	BIRTHPLACE OF MOTHER:  Hardin Co, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  ? Mrs. L. Hudson ? 
(Address)  Hardin Springs, KY
15.	Filed  5/25/1911
REGISTAR:  J. H. Comer
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  May 22, 1911
17.	I HEREBY CERTIFY, That I attended deceased from (date):  May 19, 1911 to May 22, 1911
That I last saw him/her alive on (date):  May 22, 1911
And that death occurred on the date stated above at (time AM/PM):  1:40 P.M.
THE CAUSE OF DEATH was as follows:  
Ileo-Colitis acute
(Duration)   Years:            Months:            Days:  5
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. G. Hale
Date:  May 23, 1911
Address:  Hardinsprings, 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:  Hebron Church
DATE OF BURIAL:  May 28, 1911
20.	UNDERTAKER:  Mat Dennis
ADDRESS:  Hardin Springs, KY


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Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
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