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John Michael Mullen
(1866 - 1955)
| KANSAS STATE BOARD OF HEALTH
Division of Vital Statistics |
CERTIFICATE OF DEATH |
| 55 015515 | |
1. PLACE OF DEATH
a. County Wyandotte
b. Township 1052
c. Length of Stay (in this place) 25 yrs. 1
d. City or Town Kansas City
e. Full Name of Hospital or Institution St. Margaret's Hospital
(If not in hospital or institution, give street address or location)
2. Usual Residence (Where deceased lived. If institution: residence before admission).
a. State Kansas
b. County Wyandotte 1052
c. City or Town Kansas City
d. Street Address (If rural, give location) Mt.St.Joseph's Home, 26th & Ridge
3. NAME OF DECEASED
a. (First) b. (Middle) c. (Last) Mr. John Michael Mullen, Sr.
4. Date of Death (Month, Day, Year) 10-11-55
5. SEX Male
6. COLOR OR RACE White
7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (Specify) Married
8. DATE OF BIRTH 9-2-1866
9. Age (In years last birthday) 89
10 a. Usual Occupation (Give kind of work done during most of working life, even if retired) Retired lumber broker
b. Kind of Business or Industry Lumber Broker
11. BIRTHPLACE (State or foreign country) Ludlow, Kentucky 2
12. Citizen of What Country? USA
13. FATHER�S NAME M. J. Mullen
14. MOTHER�S MAIDEN NAME Cecilia Ann Hughes 3
15. Was Deceased Ever in U.S. Armed Forces? (Yes, no, or unknown) no
(If yes, give war or dates of service) no
16. Social Security No. _________
17. INFORMANT Raymond J. Mullen, Son
MEDICAL CERTIFICATION
18. Cause of Death
Enter only one cause per line for (a), (b), and (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) Generalized Arteriosclerosis 4 INTERVAL BETWEEN ONSET AND DEATH 2 yrs
ANTECEDENT CAUSES Morbid conditions, if any, giving rise to the above cause (a) stating the underlying cause last.
DUE TO (b) ____________ INTERVAL BETWEEN ONSET AND DEATH _____
DUE TO (c) ____________ INTERVAL BETWEEN ONSET AND DEATH _____
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing death.
____________ INTERVAL BETWEEN ONSET AND DEATH _____
19 a. Date of Operation ________
b. MAJOR FINDINGS OF OPERATION ________
20. AUTOPSY? Yes ___ No X
21 a. ACCIDENT, SUICIDE, HOMICIDE (Specify) ________
b. Place of Injury (e.g., in or about home, farm, factory, street, office bldg., etc.) _____
c. (CITY, TOWN, OR TOWNSHIP) ________ (COUNTY) ________ (STATE) ________
d. Time of Injury (Month, Day, Year, hour) ________
e. Injury Occurred while at work ___ while not at work ___
f. HOW DID INJURY OCCURR? ________
22. I hereby certify that I attended the deceased from Jan. 1 , 19 55 , to Oct. 11 , 19 55
that I last saw the deceased alive on Oct. 10 , 19 55 ,
and that death occurred at 4:30 A m., from the causes and on the date stated above.
23 a. SIGNATURE J. Uaney [?] Manley, MD (Degree or title) MD
b. ADDRESS Kansas City, Kans
c. Date Signed 10-12-55
24 a. Burial, Cremation, Removal (Specify) Burial
b. Date 10-13-55
c. Name of Cemetery or Crematory Mt. Calvary Cemetery
d. Location (City, town, or country, state) Kansas City, Kansas
25. FUNERAL DIRECTOR Ralph A. Fulton, Kansas City, Kans. ADDRESS Kansas City, Kansas
Date Rec�d by Local Reg. 10-13-55
REGISTRAR�S SIGNATURE Howard Payne
1 The Mullens moved to Kansas City from Omaha, Nebraska about 1929, which is consistent with having lived in the city for 25 years.
2 John was born in Cincinnati, Ohio, not Ludlow. Ludlow is just across the Ohio River from Cincinnati. His mother died there at the home of a relative in 1922. One of her sisters had lived there for many years, and several of her children raised their families there.
3 Cecilia Hughes was the name of John's wife, not his mother. John's mother's name was Catherine McDonnell. It is probable that the information provider, John's son, became confused and gave his own mother's name instead of his father's.
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