1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hardinsburg
Inc Town:  
City:  
No.  
St.  
Ward:  2
Registration District No.:  138
Primary Registration District No:  5302
File No.  22672
Registered No:  56
2. FULL NAME:  J. P. Tucker
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6. DATE OF BIRTH:  May 8, 1868
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  43 yrs  4 mos  14 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Farmer
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Breckinridge Co.
10. NAME OF FATHER:  J. V. Tucker
11. BIRTHPLACE OF FATHER:  Breckinridge Co.
12. MAIDEN NAME OF MOTHER:  Catherine Nicholas
13. BIRTHPLACE OF MOTHER:  Breckinridge Co.
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Milton Davis
(Address)  Harned, Ky
15. Filed  Sept. 19, 1911
REGISTAR:  W. B. Lennon
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Sept. 18, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  Aug. 3, 1911 to Sept 18, 1911
That I last saw him/her alive on (date):  Aug. 3, 1911
And that death occurred on the date stated above at (time AM/PM):  9 p.m.
THE CAUSE OF DEATH was as follows:  Pulmonary Tuberculosis

(Duration)   Years:  3          Months:            Days:  
Contributory:  

(Duration)   Years:            Months:   6         Days:  
Signed (M.D.):  E. A. Lex, M.D.
Date:  9/19, 1911
Address:  Hardinsburg, Ky
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:  Scott Cemetery
DATE OF BURIAL:  Sept. 19, 1911
20. UNDERTAKER:  Robt. Weatherford
ADDRESS:  Harned, Ky

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