North Carolina State Board of Health
Office of Vital Statistics
Certificate of Death
Stamped: Dec. 7, 1915
| Registration District No: 2-5019 |
Registrar's Certificate No: |
23 |
|
|
Place of Death: County: Alexander; Township: Elendale;
Name of deceased: Dolly Cline
Sex: Female
Color/Race: White
Married
Date of Birth: Dec. 3, 1873
Age: 41yrs, 11mos, 25ds.
Usual Occupation: House keeping
Education: common school
Birth Place: Alexander Co.
Father's Name: Morgan Julian
Father's Birthplace: Alexander Co., NC
Mother's Maiden Name: Rebecca Anstian
Mother's Birthplace: Alexander Co., NC
Informant's Name & Address: J.A. Cline, Taylorsville, NC
Date of Death: Nov. 28, 1915
I hereby certify that I attended deceased from Nov. 1, 1911 to 1915. That I last saw alive on Nov. 1 1915 and that death occured on the date above stated.
Cause of Death: Heart dropsy
Signed: Samuel T. Crowson, M.D.; 1-25-1915; Taylorsville, NC.
Filed: Dec. 1, 1915
Registrar signature: G.C. Keller
Place of Burial: Antioch Church
Date of Burial: Nov. 30, 1915
Undertaker: Friends |
Transcribed from copy of original death certificate |
