1. PLACE OF DEATH County: Breckinridge Vot. Pol.: Hardinsburg Inc Town: City: No. St. Ward: 1 Registration District No.: 138 Primary Registration District No: 5381 File No. 14336 Registered No: 100 1. FULL NAME: Serena (Lerena) Gertrude Miller PERSONAL AND STATICAL PARTICULARS 2. SEX: female 3. COLOR OR RACE: white 4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single 5. DATE OF BIRTH: April 27, 1906 6. AGE (yr. mo. da) (If less than 1 day, hours or min?): 6yrs1mo13ds 7. OCCUPATION (a.) Trade, profession or particular kind of work: (b.) General nature of industry business or establishment which employed: 8. BIRTHPLACE: Breckinridge Co 9. NAME OF FATHER: Forest Miller 10. BIRTHPLACE OF FATHER: Breckinridge Co 11. MAIDEN NAME OF MOTHER: Jennie Duncan 12. BIRTHPLACE OF MOTHER: Breckinridge Co 13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) E.F. Lyons (Address) McQuady, Ky 14. Filed June 11, 1912 REGISTAR: WB Lennon MEDICAL CERTIFICATE OF DEATH 15. DATE OF DEATH: June 10, 1912 16. I HEREBY CERTIFY, That I attended deceased from (date): May 27, 1912 to June 2, 1912 That I last saw him/her alive on (date): June 2, 1912 And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: Pulmonary tuberculosis (Duration) Years: Months: Days: Signed (M.D.): E.A. Lex Date: 6/10/1912 Address: Hardin Springs 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: McQuady, Ky DATE OF BURIAL: June 11, 1912 19. UNDERTAKER: E.F. Lyons ADDRESS: McQuady, Ky