SLATE MURRILL Polly W.

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Death Certificate
MURRILL Wilson Richard
06 January 1955

[editorial comment]
[Originally posted at Evelyn & Alvin Brown @ Ancestry.com ]

522.2 2.5
Texas Department of Health
Bureau of Vital Statistics
Certificate of Death
State File No.: [stamp] 956
State of Texas
1. Place of Death: a. County: Coleman
b. City or Town or Precinct No: Novice
c. Length of Stay (in this place): [blank]
d. Full Name of Hospital or Institution: [blank]
2. Usual Residence (Where deceased lived.)
a. State: Texas
b. County: Coleman
c. City or Town: Novice
d. Street Address: [blank]
3. Name of Deceased: Wilson Richard Murrill
4. Date of Death: January 6, 1955
5. Sex: Male
6. Color or Race: White
7. Married, Never Married, Widowed or Divorced: Married
8. Date of Birth: Sept. 1, 1882
9. Age, Years, Months, Days, If less than 1 Day Hours, Min: 72 years, 4 months, 5 days
10a. Usual Occupation: Farmer
10b. Kind of Industry or Business: [blank]
11. Birthplace (state or country): Novice, Texas
12. Father, Name: James Henry Murrill
12. Father, Birthplace: Virginia
13. Mother, Maiden Name: Polly Slate
13. Mother, Birthplace: Missouri
14. Was Deceased Ever in U.S. Armed Forces, (Yes, no, or unknown, If yes, give war or dates of service): [blank]
15. Social Security No.: 525-12-1636
16. Informant's Signature: Mrs. W. R. Murrill [Ethel Effie DYER MURRILL]
17. Cause of Death, Enter only one cause per line a, b, c
I. Disease or Condition Directly Leading to Death *(This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death.
(a) Myocarditis, 1 year
Antecedent Causes, Due to (b) [blank]
II. Other Significant Conditions, Conditions contributing to the death but not related to the disease or condition causing death.: Enlarged prostate operated last Spring. one [unable to read] removed, one year
18a. Date of Operation: [blank]
18b. Major Findings of Operation: [blank]
19. Autopsy? No
20a. Accident, Suicide
...
21. I hereby certify that I attended the deceased from 1 - 6, 1955, to 1 - 6, 1955, that I last saw the deceased dead on 1 - 6, 1955, and that death occurred at 2:34 A.M., from the causes and on the date stated above.
22a. Signature: J. C. Young M. D.
22b. Address: Coleman, Texas
22c. Date Signed: 1 - 6 - 55
23a. Burial, Cremation, Removal: Burial
23b. Date: Jan. 7, 1955
23c. Name of Cemetery or Crematory: Atoka
23d. Location: Coleman County, Texas
24. Funeral Director's Signature: Jos. C. Stevens
25a. Register's File No: Seven
25b. Date Rec'd by Local Registrar: February 4th, 1955
25c. Registrar's Signature: [unable to read]
Post Office Address: Cuero, Texas
[stamp] Texas Department of Health, Received Feb, 9 1955, Bureau of Vital Statistics
Note the information called for on the reverse side.
[end]

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