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File contributed for use in USGenWeb Archives by:
Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
http://www.usgwarchives.net

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1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Hudson, Ky
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5316
Primary Registration District No:  
File No.  437
Registered No:  3
2. FULL NAME:  Lessour Pullen
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Male
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Single
6. DATE OF BIRTH:  1/15/1912
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  1 ds
8. OCCUPATION (a.) Trade, profession or particular kind of work:  
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  
10. NAME OF FATHER:  Mansfield Pullen
11. BIRTHPLACE OF FATHER:  Kentucky
12. MAIDEN NAME OF MOTHER:  Ellegood
13. BIRTHPLACE OF MOTHER:  Kentucky
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Nellie Ellegood
(Address)  Hudson, Ky
15. Filed  2/2, 1912
REGISTAR:  J. H. Comer
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  Jan, 16, 1912
17. I HEREBY CERTIFY, That I attended deceased from (date):  Jan 15, 1912 to 
That I last saw him/her alive on (date):  Jan 15, 1912
And that death occurred on the date stated above at (time AM/PM):  5 p.m.
THE CAUSE OF DEATH was as follows:  Atelectasis

(Duration)   Years:            Months:            Days:  1 and 7 hrs.
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S. J. Hall, M.D.
Date:  Jan. 16, 1912
Address:  Constantine
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:  Coyles Grave Yd.
DATE OF BURIAL:  1/17, 1912
20. UNDERTAKER:  J. D. Pullen
ADDRESS:  Hudson, Ky


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Copyright.  All rights reserved.
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