1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Hudson Inc Town: City: No. St. Ward Registration District No.: Primary Registration District No: 5316 File No. 19028 Registered No: 10 1. FULL NAME: Lena Mercer PERSONAL AND STATICAL PARTICULARS 2. SEX: female 3. COLOR OR RACE: white 4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married 5. DATE OF BIRTH: 10/9/1890 6. AGE (yr. mo. da) (If less than 1 day, hours or min?): 27yrs9mos24ds 7. OCCUPATION (a.) Trade, profession or particular kind of work: house work (b.) General nature of industry business or establishment which employed: 8. BIRTHPLACE: Kentucky 9. NAME OF FATHER: S.J. Hudson 10. BIRTHPLACE OF FATHER: Ky 11. MAIDEN NAME OF MOTHER: Carman 12. BIRTHPLACE OF MOTHER: Ky 13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) F. Mercer (Address) Constantine 14. Filed 8/8/1912 REGISTAR: JH Comer MEDICAL CERTIFICATE OF DEATH 15. DATE OF DEATH: 8/7/1912 16. I HEREBY CERTIFY, That I attended deceased from (date): Feb 8, 1912 to 7-10-1912 That I last saw him/her alive on (date): 7-15-1912 And that death occurred on the date stated above at (time AM/PM): 5AM THE CAUSE OF DEATH was as follows: Tuberculosis pulmonatis (Duration) Years: Months: 6 Days: 7 Contributory: Measles Signed (M.D.): S.J. Hall Date: 8/7/1912 Address: Constantine 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: Sharp Cemetery DATE OF BURIAL: 8/8/1912 19. UNDERTAKER: Alf Taylor ADDRESS: Custer, Ky