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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  BIG SPRING
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5314
Primary Registration District No:  14
File No.  29362
Registered No: 27 
2.	FULL NAME:  BULLOCK, WILLIAM H.
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  MARRIED
6.	DATE OF BIRTH:  AUG 22, 1848
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  67 / 3 / 19
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  MERCHANT
(b0.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  KENTUKCY
10.	NAME OF FATHER:  UNKNOWN
11.	BIRTHPLACE OF FATHER:  UNKNOWN
12.	MAIDEN NAME OF MOTHER:  UNKNOWN
13.	BIRTHPLACE OF MOTHER:  UNKNOWN
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  JONAS ALGOOD
(Address)  BIG SPRING
15.	Filed  DEC 17, 1915
REGISTAR:  J.L. MORRIS
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  DEC 11, 1915
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOT AT ALL
That I last saw him/her alive on (date):  
And that death occurred on the date stated above at (time AM/PM):  3 AM
THE CAUSE OF DEATH was as follows:  ORGANIC HEART TROUBLE FROM HISTORY OF CASE - WAS DEAD WHEN I --- HIM
(Duration)   Years:            Months:            Days:    1 1/2 DAYS
Contributory:  
(Duration)   Years:            Months:            Days:  
Signed (M.D.):  C.B. WITT
Date:  DEC 11, 1915
Address:  BIG SPRING
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:  GARFIELD, KY
DATE OF BURIAL:  DEC 12, 1915
20.	UNDERTAKER:  CLIFF ALGOOD
ADDRESS:  CUSTER


ADDITIONAL COMMENTS/NOTES:




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