Marshal Sullivan -- July 22, 1926
(Transcribed by David B Dunn)
B.V.S. FORM 11
NORTH CAROLINA STATE BOAD OF HEALTH 195
BUREAU OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
1. PLACE OF DEATH:
County: Duplin Registration Dist. No. 315388 Registrar No. 15
2. FULL NAME: Marshal Sullivan
(a) Residence: Blank
PERSONAN AND STATISTICAL PARTICULARS
3. SEX: Male 4. COLOR: White 5. Marital status: Married
5a Wife: Blank
6. DATE OF BIRTH : Blank 7. AGE: 66 YEARS 11 MONTHS 20 DAYS
8. TRADE: Farmer 8a. PLACE WHERE TRADE IS DONE: Blank
8b General nature of Occupation: Blank 8c. NAME OF EMPLOYER: blank
9. BirthPlace: Wolfscrape Township,Duplin County N.C.
10. FATHERS NAME: Elisha Sullivan 11. BIRTHPLACE OF FATHER:
Duplin County N.C.
12. MOTHERS MADEN NAME: Nancy Jane Blalock 13.BIRTH PLACE
OF MOTHER: N. C.
14 INFORMANT: C. J Brock Kenansville, N.C.
15. D. N. Brock Registrar
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: July 22, 1926
17. I HEREBY CERTIFY, That I attended deceased from Blank to Blank
I last saw him alive Blank. Death is said to
have Occurred on the date stated above, at
Blank pm. The principle Cause of death
and related causes of importance in order of
Onset were as follows: Died Sudden no
19. PLACE OF BURIAL, CREMATION, OR REMOVAL: O’Daniel Graveyard
July 23, 1926
20. Undertaker: C. J. Brock Kenansville, N.
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