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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  CUSTER
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  15
File No.  3509
Registered No:65  
2.	FULL NAME:  OLIVER, SUSAN M. LYONS
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  FEMALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  JAN 22, 1840
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  74 / - / 28
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  HOUSEKEEPER
9.	BIRTHPLACE:  CUSTER, BRECKINRIDGE, KY
10.	NAME OF FATHER:  JOHN LYONS
11.	BIRTHPLACE OF FATHER:  CUSTER, BRECKINRIDGE, KY
12.	MAIDEN NAME OF MOTHER: POLLY L. BASHAM 
13.	BIRTHPLACE OF MOTHER:  CUSTER, BRECKINRIDGE, KY
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  GEORGE MILBURN
(Address)  CUSTER
15.	Filed  FEB 19, 1914
REGISTAR:  J.S MITCHAM
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  FEB 19, 1914
17.	I HEREBY CERTIFY, That I attended deceased from (date):  FEB 15, 1914 to FEB 19, 1914
That I last saw him/her alive on (date):  FEB 18, 1914
And that death occurred on the date stated above at (time AM/PM):  5 AM
THE CAUSE OF DEATH was as follows:  LOBAR PNEUMONIA
(Duration)   Years:            Months:            Days:    8
Contributory:  SENILITY
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J.A. SANDBACH
Date:  FEB 19, 1914
Address:  GARFIELD
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:  GOOD HOPE
DATE OF BURIAL:  FEB 19, 1914
20.	UNDERTAKER:  ALF TAYLOR
ADDRESS:  CUSTER


ADDITIONAL COMMENTS/NOTES:




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