1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  12
Inc Town: Irvington 
City:  Irvington
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  25011
Registered No:  13
2. FULL NAME:  Lyddan, Mike L.
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widower
6. DATE OF BIRTH:  Oct. 15, 1822
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  88 yr 11 mo 16 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Retired farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hardin Co., KY
10. NAME OF FATHER:  
11. BIRTHPLACE OF FATHER:  
12. MAIDEN NAME OF MOTHER:  
13. BIRTHPLACE OF MOTHER:  
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  G. N. Lyddan
(Address)  Irvington, KY
15. Filed  Oct. 2, 1911
REGISTAR:  D. W. Henry
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Oct. 1, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Sept. 29, 1911
That I last saw him/her alive on (date):  Oct. 1, 1911
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  Senile Pneumonia

(Duration)   Years:            Months:        3    Days:  
Contributory:  Infirmities of age

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S. P. Parks
Date:  Oct. 1, 1911
Address:  Irvington, 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:  Irvington, KY
DATE OF BURIAL:  Oct. 2, 1911
20. UNDERTAKER:  G. T. Marshall & Son
ADDRESS:  Irvington, KY