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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  Hardinsburg
City:  
No.  
St.  
Ward:  2
Registration District No.:  5302
Primary Registration District No:  130
File No.  19013
Registered No:  108
2. FULL NAME:  Thomas Lawrence Smith
PERSONAL AND STATICAL PARTICULARS
3. SEX:  male
4. COLOR OR RACE:  white
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  married
6. DATE OF BIRTH:  Nov 19, 1854
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  57 years, 8 months, 13 days
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Blacksmith
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Hardinsburg, Ky
10. NAME OF FATHER:  John Coleman Smith
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Hetty Leaman
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) James Smith
(Address)  Hardinsburg, Ky
15. Filed  Aug 1, 1912
REGISTAR:   W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Aug 1, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  
That I last saw him/her alive on (date):  July 31, 1912
And that death occurred on the date stated above at (time AM/PM):  8 a.m.
THE CAUSE OF DEATH was as follows:  Apoplexy  sudden [sudden is underlined]

(Duration)   Years:            Months:            Days:  
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  A. W. Kincheloe, M.D.
Date:  8-1-1912
Address:  Hardinsburg
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:  St. Romuald Cemetery
DATE OF BURIAL:  Aug 2, 1912
20. UNDERTAKER:  J. T. Hoben
ADDRESS:  Hardinsburg


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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