James Monroe McCullough, Vernon Parish Louisiana
Submitted by Bill Mccullough
Date: June 2, 2008

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Louisiana State Board Of Health
Bureau of Vital Statistics
Certificate of Death
Ward District No. 43-5421B
File No. 3
Registered No. 8306

Jul 11 1930
1 - Place of Death
    Parish: Sabine
    Police Jury Ward: 1
    Village/City: Peason
2 - Full Name: James M. McCullough
    Residence: Peason La.

Personal and Statistical Particulars
3. Sex: Male
4. Race: White
5. Single, Married, Widowed or Divorced: married
5a. Husband of: Emily McCullough 
6. Date of Birth: 3/12/1884
7. Age: 46 Years 3 Months 5 Days
8. Occupation: Farmer
9. Birthplace: Vernon Ph La.
10. Name of Father: J.B.McCullough
11. Birthplace of Father: La
12. Name of Mother: Hariett Bryant
13. Birthplace of Mother: La.
14. Informant: Blank
15. Filed: 7-10, 1930  Ruth P Goode(Registar)

Medical Certificate of Death
16. Date of Death: 6/17/30
17. I HEREBY Certify, That I attended deceased from 6/7/30 to 6/17/30,
    that I last saw h.. alive on 6/17/30 and that death occurred,
    on that date stated above, at 3.30 _.M.
    The Cause of Death was as follows:
    Mitral Insufficiency
18. (Signed) W.T. Franklin, M.D.
    (Address) Peason La
19. Place of Burial, Cremation, or Removal: Blue Branch
    Date of Burial: 6/1?/30