1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Hardinsburg
Inc Town:
City:
No. 5301
St.
Ward
Registration District No.: 130
Primary Registration District No:
File No. 25001
Registered No: 64
1. FULL NAME: Lydia Jane Miller
PERSONAL AND STATICAL PARTICULARS
2. SEX: female
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: Feb 6, 1875
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 36yrs8mos23ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: house wife
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Kentucky
9. NAME OF FATHER: James Duncan
10. BIRTHPLACE OF FATHER: Kentucky
11. MAIDEN NAME OF MOTHER: Elminor Pate
12. BIRTHPLACE OF MOTHER: Kentucky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Forest Miller
(Address) McQuady, Ky
14. Filed Oct 30, 1911
REGISTAR: WB Lennon
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Oct 29, 1911
16. I HEREBY CERTIFY, That I attended deceased from (date): Oct 13, 1911 to Oct 29, 1911
That I last saw him/her alive on (date): Oct 29, 1911
And that death occurred on the date stated above at (time AM/PM): 6PM
THE CAUSE OF DEATH was as follows:
Typhoid Fever
Contributory: Child Birth
(Duration)
Years:
Months:
Days: 16
Signed (M.D.): W.H. Lucas
Date: Oct 30, 1911
Address: McQuady, Ky
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: Oct 30, 1911
19. UNDERTAKER: EF Lyons
ADDRESS: McQuady, Ky