North Carolina State Board of Health
Office of Vital Statistics
Certificate of Death
Stamped: Dec. 7, 1953
| Registration District No: 02-00 |
Registrar's Certificate No: |
25584 |
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Place of Death: County: Alexander; Township: Ellendale; Length of stay: Life; City/Town: Taylorsville; Not in city limits; Location: Route 2.
Usual Residence: State: NC; County: Alexander; City/Town: Taylorsville, Not in city limits; Address: Route 2.
Name of deceased: Barbara Jane Smith
Date of Death: 11-11-53
Sex: Female
Color/Race: White
Widow
Date of Birth: 8-27-1873
Age: 80 years
Usual Occupation: Housewife
Birth Place: Alexander Co., NC
Citizen of USA
Father's Name: Max Cline
Mother's Maiden Name: Dinah Barger
Informant's Name & Address: Mrs. W.M. Richie, Route 2, Taylorsville, N.C.
Cause of Death: Infirmities of age.
I attended the deceased from 11-1-1953 to 11-11-1953 and last saw him alive on 11/11/1953. Death occurred at 7:45AM on the date stated and to the best of my knowledge from the causes stated.
Signature: Roy C. TatumMD, Address: Taylorsville, NC. Date: 11-12-53
Burial Date: 11-12-53. Cemetery: Antioch Bapt Ch.; Location: Alexander Co., NC
Date rec'd by local Reg: 11-27-53
Registrar signature: Benton D. Scott
Funeral Director: Hickory Fun'l Home, Hickory, NC |
Transcribed from copy of original death certificate |
