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Catherine (McDonnell) Mullen
(1842 - 1922)
COMMONWEALTH OF KENTUCKY
State Board of Health
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
File No. 5157?
Registered No. 779
County Kenton
Vot. Pct. _____________ Registration District No. 791
Inc. Town Ludlow Primary Registraion District No. 2291
City ______________ (No. 38 Ash St. ____Ward)
(If death occurred in a hospital or institution, give its NAME instead of street and number.)
2. FULL NAME Catherine Mullen
PERSONAL AND STATISTICAL PARTICULARS
3. SEX F
4. COLOR OR RACE W
5. Single, Married, Widowed, or Divorced (write the word) Widow
6. DATE OF BIRTH (month, day, year) Mch 19 , 1 842
7. AGE 80 Years 6 Months 12 Days
8. OCCUPATION
(a) Trade, profession, or particular kind of work At home
(b) General nature of industry, business or establishment in which employed (or employer)__________
(c) Name of Employer __________
9. BIRTHPLACE (State or country) Ireland
10. NAME OF FATHER McDonnell
11. BIRTHPLACE OF FATHER (State or country) Ireland
12. MAIDEN NAME OF MOTHER Needham
13. BIRTHPLACE OF MOTHER (State or country) Ireland
14. The above is true to the best of my knowledge
(Informant) John M Mullen
(Address) Omaha Neb
15. Filed Nov-10 , 192 2 Alice Pettilme Registrar
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH (month, day, and year) Oct 1 ,192 2 ,
17. I HEREBY CERTIFY, That I attended deceased from Sept 1[19?] , 192 2 , to Oct 1 , 192 2 ,
that I last saw h__ alive on Oct 1 , 192 2 , and that death occurred on the date stated above at ____m.
The CAUSE OF DEATH* was as follows:
Myocarditis 1 (Duration) ___ yrs. ___mos. ___ds.
Contributory (Secondary) ___________ (Duration) ____ yrs. ____mos. ___ds.
(Signed) L. C. Hafer? ,2 M.D. Oct 2, 192 2 (Address) Ludlow Ky
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients or Recent Residents)
at place of death ___ yrs. ___mos. ___ds. In the State ___ yrs. ___mos. ___ds.
Where was disease contracted, if not at place of death? __________
Former or usual residence __________
19. PLACE OF BURIAL OR REMOVAL St. Jos Cem Ohio
DATE OF BURIAL Oct 3 , 192 2
20. UNDERTAKER John Allison ADDRESS Cov Ky
1 Myocarditis is an inflammation or degeneration of the heart muscle. It causes symptoms of heart failure, which may mimic a heart attack. It is an uncommon disorder most often caused by viral infection, but may also appear as a primary disease in adults or as a degenerative disease of old age.
2 Louis C. Hafer, medical physician, is enumerated in the 1920 Federal Census living with his wife Catherine and daughters Georgia and Mary on Kenner St. in Ludlow, Kenton, Kentucky.
