North Carolina State Board of Health
Office of Vital Statistics
Certificate of Death
Stamped: Oct. 10, 1966
| Registration District No: 02-00 |
Registrar's Certificate No: |
28269 |
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Place of Death: County: Alexander; Township: Ellendale; City/Town: Taylorsville; Not in city limits; Location: Route 2, Taylorsville, NC
Usual Residence: State: NC; County: Alexander; City/Town: Taylorsville, Not in city limits; On a Farm; Address: Route 2, Taylorsville.
Name of deceased: Perry Lee Cline
Date of Death: 9-27-66
Sex: Male
Color/Race: White
Married
Date of Birth: 2-2-1900
Age: 66 years
Usual Occupation: Retired
Kind of Business: HKY MFG. Co.
Birth Place: North Carolina
Citizen of USA
Father's Name: Jim Cline
Mother's Maiden Name: Dora Cline
Name of Spouse: Pearl Johnson
Informant's Name & Address: Mrs. Perry L. Cline, Route 2, Taylorsville, N.C.
Cause of Death: Coronary Occlusion, duration: sudden; due to atherosclerosis, severe, carthal, due to bronchitis, _______, emphysema.
I attended the deceased from 1963 to 27 Sept. 1966 and last saw him alive on 13 Sept. 1966. Death occurred at 8:30AM on the date stated and to the best of my knowledge from the causes stated.
Signature: (illegible), Address: Granite Falls, NC. Date: 10-5-66
Burial Date: 9-29-66. Cemetery: Antioch Bapt Ch. Cem.; Location: Alexander Co., NC
Date rec'd by local Reg: 10/6/66
Registrar signature: W.H. Brandie, MD (SD)
Funeral Director: HKY Funeral Home, Hickory, NC |
Transcribed from copy of original death certificate |
