Mary Shaws Bounds McCullough, Rapides Parish Louisiana
Submitted by Bill McCullough
Date: June 2008

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Louisiana State Board of Health
Bureau of Vital Statistics
Certificate of Death
Registration District No.: 40-5395
File No: 195
Primary Registration District No.: Blank
Registered No.: 11169
Sep 12 1927

1 - Place of Death
Parish: Rapides
Police Jury Ward 5
Village: Blank
City: Blank

2 - Full Name: Mrs Mary McCloug
    Residence: State: La Ward 5

Personal and Statistical Particulars
3 Sex: F
4 Color or Race: W
5 Single, Married, Widowed or Divorced: Married
5a Wife of: JB McClough
6 Date of Birth: Blank
7 Age: 61 Years 8 Months 7 Days
8 Occupation of Deceased: Farmer
  Nature of Industry: Farming
  Name of Employer: None
9 Birthplace: Hancock Miss
10 Name of Father: Martin Shaws
11 Birthplace of Father: Blank
12 Maiden Name of Mother: Blank
13 Birthplace of Mother: Blank
14 Informant: Blank
15 Filed 9/6, 1927  W.G. Gilbert (Registar)

Medical Certificate of Death
16 Date of Death: Sept. 1st 1927
17 I Hereby Certify, That I attended deceased from
   March 22, 1927 to Sept 1st 1927 that I last saw her alive on May 27th 1927 
   and that death occurred, on datee stated above, at 9:00pm.
   The Cause of Death was as follows:
   [see copy of certificate]
18 Did an operation precede death? No
   Was there an autopsy? No
   What test confirmed diagnosis? Clinical
   (Signed) illegible, M.D.
20 (Undertaker) JR Audris
   (Address) Glenmora La