************************************************************************ 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.: HARDINBURG Inc Town: City: No. St. Ward: Registration District No.: 130 Primary Registration District No: 5302 File No. 9514 Registered No:17 2. FULL NAME: TUCKER, VOLENTINE PERSONAL AND STATICAL PARTICULARS 3. SEX: MALE 4. COLOR OR RACE: WHITE 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED: MARRIED 6. DATE OF BIRTH: MAR 10, 1913 [as written] 7. AGE (yr. mo. da) (If less than 1 day, hours or min?): 77 / 1 / 19 8. OCCUPATION (a.) Trade, profession or particular kind of work: FARMER (b.) General nature of industry business or establishment which employed: 9. BIRTHPLACE: KENTUCKY 10. NAME OF FATHER: PLEASANT TUCKER 11. BIRTHPLACE OF FATHER: BRECKINRIDGE 12. MAIDEN NAME OF MOTHER: 13. BIRTHPLACE OF MOTHER: 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant) (Address) 15. Filed APR 30, 1913 REGISTAR: W.B. LEAMAN MEDICAL CERTIFICATE OF DEATH 16. DATE OF DEATH: APR 29, 1913 17. I HEREBY CERTIFY, That I attended deceased from (date): That I last saw him/her alive on (date): And that death occurred on the date stated above at (time AM/PM): THE CAUSE OF DEATH was as follows: SOMETHING LIKE CRAMP COLIC - PATIENT DIED BEFORE A PHYSICIAN COULD ARRIVE (Duration) Years: Months: Days: Contributory: (Duration) Years: Months: Days: Signed (M.D.): J.C. MATTHEWS Date: APR 13, 1913 Address: WESTVIEW 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 BURIAL GROUND DATE OF BURIAL: MAY 1, 1913 20. UNDERTAKER: ROBERT WEATHERFORD ADDRESS: HARNED 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 ************************************************************************