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DEATH
CERTIFICATE
LESLIE MULLINS
Date 21 June 1946
Cert: 14842
Place of Death: County: Fayette City or Town: Lexington
Name of Hospital or Institution: Eastern State Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County: Knott
City or Town: Sassafras
Full Name: Leslie MULLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: September 1910
Age: 35 years
Birthplace: Kentucky, Knott County
Occupation: Truck driver
Industry or business: (blank)
Father Name: dead
Father Birthplace: (blank)
Mother Maiden Name: Elizabeth CLINE MULLINS
Mother Birthplace: Virginia
Informant: Hospital Records, Lexington, Ky.
Burial Place: Hazard, Ky.
Date: 25 June 1946
Signature funeral director: Lowe F. Home, by
Meritt Martin, Lex., Ky.
Date received by local registrar: 02 July 1946
Registrar's Signature: D. A. Furlong
Date of Death: 21 June 1946
I hereby certify that I attended deceased from 08 April 1946
to 21 June 1946, that I last saw him alive on 21 June 1946,
and that death occurred on the date stated above at 3:25 p.m.
Immediate cause of death: Psychosis with Syphilis of the
Central Nervous System, Meningo-encephalitic Type
Duration: 2 yrs
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: A. C. Beckett, M.D., E. S. Hosp.
Date signed: 21 June 1946
Transcribed by Debbie Tamborski, 10 February 2010 |
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