| 1. |
Place of Death |
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a. |
County: Alamance |
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b. |
Township: blank |
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c. |
City or town: Burlington |
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d. |
Street, hospital or institution: 201 Markham St. |
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e. |
blank |
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| 2. |
Home (usual residence) of deceased |
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a. |
State: N.C. |
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b. |
County: Alamance |
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c. |
City or town: Burlington |
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d. |
Street: 201 Markham St. |
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e. |
Is place of residence in corporate limits? yes |
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f. |
blank |
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| 3. |
a. |
Full Name: Oliver Darius Hawn |
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b. |
Veteran: blank |
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c. |
social security No.: blank |
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| 4. |
Sex: Male |
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| 5. |
Color or Race: White |
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| 6. |
a. |
Married |
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b. |
Name of wife: Leila Bost |
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c. |
Age of wife: blank |
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| 7. |
Birth date: 8-15-1878 |
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| 8. |
Age: 69 years, 3 months, 4 days |
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| 9. |
Birthplace: Catawba Co. |
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| 10. |
Usual Occupation: blank |
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| 11. |
Industry or business: blank |
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| 12. |
Father's Name: Abner Hawn |
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| 13. |
Father's Birthplace: N.C. |
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| 14. |
Mother's maiden name: Catherine Rink |
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| 15. |
Mother's birthplace: N.C. |
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| 16. |
a. |
Informant's Signature: P.R. Hawn |
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b. |
Address: Fayetteville, N.C. |
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| 17. |
a. |
Burial, cremation, removal: Burial |
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b. |
Date thereof: 11-21-47 |
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c. |
Cemetery: Pine Hill |
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d. |
Location: Burlington, N.C. |
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| 18 |
a. |
Funeral director: Burke Funeral Home |
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b. |
Address: Burlington, N.C. |
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| 19. |
a. |
Filed: 11-25-1947 |
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b. |
Registrar signature: Mrs. J.H. Heruon |
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| 20. |
Date of death: 11-19-47 |
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| 21. |
I certify that death occurred as the date above stated: that I attended deceased from 11-19-1947 and that I last saw him alive on 11-19-1947.
Immediate cause of death: Cerebral Apoplexy dut to artirial Hypertension. |
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| 22. |
blank |
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| 23. |
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Signature: H.B. Moore, M.D. |
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Address: Burlington, N.C. |
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Date Signed: 11-22-47 |
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| Source: photo copy of original document |
