1 |
Place of Death |
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a. |
County: Cherokee |
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b. |
Township: Murphy |
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c. |
Length of stay: blank |
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d. |
City or Town: Murphy; Is place of death within city limits: Yes |
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e. |
Full Name of hospital or institution: Providence Hosp. |
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2. |
Usual Residence |
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a. |
State: North Carolina |
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b. |
County: Cherokee |
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c. |
City or Town: Andrews; Is place of residence in city limits? yes |
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d. |
street adress: blank |
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3. |
Name of deceased: Elizabeth B. Scruggs |
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4. |
Date of death: 4-2-1962 |
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5. |
Sex: Female |
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6. |
Color or Race: White |
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7. |
Married |
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8. |
Date of Birth: 3-20-98 |
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9. |
Age: 64 yrs, 0 mos, 13 dys |
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10 |
a. |
Usual Occupation: Housewife |
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b. |
blank |
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11. |
Birthplace: Browing Rock, North Carolina |
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12 |
Citizen of what country: USA |
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13 |
Father's Name: H. Coleman Brown |
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14 |
Mother's Maiden Name: Alice Frye |
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Name of husband or wife: William H. Scruggs |
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15. |
Was deceased ever in US Armed forces: No |
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16. |
Social Security No.: None |
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17. |
Informant's name and address: Dr.William H. Scruggs, Andrews, N.C. |
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18 |
Cause of death: Pulmonary Emphysema |
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II |
Other significant conditions: Hypertensive Cardiovascular disease & failure |
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19 |
Was autopsy performed: No |
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20. blank |
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21. |
I attended the deceased from 3-27-1962, to 4-2-1962 and las saw her alive on 4-2-1962. Death occurred at 6:10pm on the date stated above; and to the best of my knowledge form the causes stated. |
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22 |
a |
Signature: W.A. Hoover M.D. |
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b. |
Address: Murphy, N.C. |
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c. |
Date signed: 4-3-62 |
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23 |
a |
Burial, cremation, removal: Burial |
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b. |
Date: 4-4-62 |
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c. |
Name of cemetery or crematory: East View |
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d. |
Location: Newton, N.C. |
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24 |
Date rec'd by local reg.: 4-7-62 |
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25 |
Registrar's Signature: Bessie E. Dewease |
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26. |
Funeral director & address: Trie Funeral Home - Murphy, N.C. |
