1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Mook
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5314
Primary Registration District No:  
File No.  267
Registered No:  1
2. FULL NAME:  Lucas, Thomas Lee
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  Nov. 15, 1910
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 yr 1 mo 22 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  None
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  KY
10. NAME OF FATHER:  Henry Lucas
11. BIRTHPLACE OF FATHER:  KY
12. MAIDEN NAME OF MOTHER:  Arnus
13. BIRTHPLACE OF MOTHER:  KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Charlie Arnus
(Address)  Mook, KY
15. Filed  Jan. 7, 1911
REGISTAR:  V. G. Goodman
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Jan. 7, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Dec. 22, 1910
That I last saw him/her alive on (date):  Jan. 5, 1911
And that death occurred on the date stated above at (time AM/PM):  3 AM
THE CAUSE OF DEATH was as follows:  Simple Cerebral Meningitis

(Duration)   Years:            Months:      10     Days:  
Contributory:  Bronchitis Acute

(Duration)   Years:            Months:         15   Days:  
Signed (M.D.):  J. E. Matthews
Date:  Jan. 7, 1911
Address:  Westview, 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:  Fairview
DATE OF BURIAL:  Jan. 8, 1911
20. UNDERTAKER:  Joe Vertrees
ADDRESS:  Mook, KY