1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg, KY
Inc Town:  
City:  
No.  
St.  
Ward:  2
Registration District No.:  
Primary Registration District No:  5302
File No.  17178
Registered No:  38
2. FULL NAME:  Lyons, Margorette Ann
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  Feb. 4, 1847
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  64 yr 4 mo 0 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housekeeper
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Custer, KY
10. NAME OF FATHER:  J. E. Priest
11. BIRTHPLACE OF FATHER:  Custer, KY
12. MAIDEN NAME OF MOTHER:  Unknown
13. BIRTHPLACE OF MOTHER:  Custer, KY
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Arthur Horsely
(Address)  Garfield, KY
15. Filed  July 5, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  July 4, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  June 28, 1911
That I last saw him/her alive on (date):  July 4, 1911
And that death occurred on the date stated above at (time AM/PM):  11 PM
THE CAUSE OF DEATH was as follows:  Pneumonia

(Duration)   Years:            Months:       6     Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. A. Sandbach
Date:  July 5, 1911
Address:  Garfield, 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:  Garfield Cemetery
DATE OF BURIAL:  July 5, 1911
20. UNDERTAKER:  J. B. Richardson
ADDRESS:  Garfield, KY