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