************************************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/ky/kyfiles.html ************************************************************************ 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. 20323 Registered No: 79 2. FULL NAME: SUTTON, LUCY SIPES PERSONAL AND STATICAL PARTICULARS 3. SEX: FEMALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: DEC 16, 1867 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 46 / 8 / 10 8. OCCUPATION (a.) Trade, profession or particular kind of work: AT HOME (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: BRECKINRIDGE 10. NAME OF FATHER: WILLIAM SIPES 11. BIRTHPLACE OF FATHER: KENTUCKY 12. MAIDEN NAME OF MOTHER: SOPHIA WHITWORTH 13. BIRTHPLACE OF MOTHER: KENTUCKY 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) ELBA BUTLER (Address) CUSTER 15. Filed AUG 27, 1914 REGISTAR: J.S. MITCHAM MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: AUG 26, 1914 17. I HEREBY CERTIFY, That I attended deceased from (date): FEB 1914 to AUG 1914 That I last saw him/her alive on (date): AUG 10, 1914 And that death occurred on the date stated above at (time AM/PM): 9 AM THE CAUSE OF DEATH was as follows: TUBERCULOSIS OF LUNGS AND THROAT (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.W. MEADOR Date: AUG 27, 1914 Address: CUSTER 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: AUG 27, 1914 20. UNDERTAKER: TAYLOR & GRAY ADDRESS: CUSTER ADDITIONAL COMMENTS/NOTES: ************************************************************************ File contributed for use in USGenWeb Archives by: Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067 http://www.usgwarchives.net ************************************************************************