MURRILL ANDERSON Ann Staton

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Death Certificate
SLATE MURRILL Polly W.
29 May 1934

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

Texas State Board of Health
Bureau of Vital Statistics
Standard Certificate of Death
State File No.: [stamp] 70739

1. Place of Death:
County: Coleman
City: Novice
2. Name of Deceased: Polly W. Murrill
3. Sex: Female
4. Color or Race: White
5. Married, Never Married, Widowed or Divorced: Widowed
6. Date of Birth: November 15, 1861
7. Age, Years, Months, Days, If less than 1 Day Hours, Min: 72 years, 6 months, 16 days
8 Occupation: House keeping
General nature of Industry: [blank]
9. Birthplace (state or country): Oregon, Missouri
10. Name of Father: S. J. Slate
11. Birthplace of Father: [blank]
12. Maiden Name of Mother: Elizabeth Johnson
13. Birthplace of Mother: [blank]
14. The above is true
(Informant's Signature) Mr. and Mrs. Matt Anderson [Daughter Ann S. MURRILL ANDERSON and husband J. Matt ANDERSON]
(Address) Novice, Texas
15. Filed: 6-6-34 Jas. R. Reed
16. Date of Death: May 29, 1934
17. I hereby certify that I attended the deceased from April 1927, to May 29, 1934, that I last saw her alive on May 27, 1934, and that death occurred, on the date stated above at 7:40 A.M.

The Cause of Death as as follows: Chronic Bronchitis with [unable to read], (duration) 20 years.
Contributory: her age
(duration) 72 yrs. 6 mos. 16 ds.

18. [unable to read]
Did an operation proceed death? no
Was there an autopsy? no
(Signed) [unable to read] M. D.
May 20, 1934 (Address) Novice
19. Place of Burial or Removal: Atoka (near Novice)
Date of Burial May 30, 1934
20. Undertaker: J. W. Mead
Address: Coleman
Form 31b-Y36-2-21-1003
[stamp] Texas Department of Health, Received Jul 5 1934, Texas, Bureau of Vital Statistics
[end]

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