1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Bewleyville
Inc Town:
City:
No. 5312
St.
Ward
Registration District No.:
Primary Registration District No:
File No. 27312
Registered No:
1. FULL NAME: Lavinda Meador
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white 
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: widowed
5. DATE OF BIRTH: Mar 1830
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 81yrs7 mos
7. OCCUPATION (a.) Trade, profession or particular kind of work: none
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Ky
9. NAME OF FATHER:  H.G. Pile
10. BIRTHPLACE OF FATHER: Ky
11. MAIDEN NAME OF MOTHER: Hannah
12. BIRTHPLACE OF MOTHER: Breckinridge Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Thos. Wilson
(Address) 
14. Filed
REGISTAR: John Compton
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Oct  25, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Oct 1, 1911
That I last saw him/her alive on (date): Oct 25, 1911
And that death occurred on the date stated above at (time AM/PM): 4 PM
THE CAUSE OF DEATH was as follows:
Infirmaties of old age
(Duration)
Years:
Months:
Days:
Signed (M.D.): J.M. Walker
Date: Oct 1911
Address: Irvington R1
17. 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:
18. PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL:
19. UNDERTAKER:
ADDRESS: