| 1. |
Place of Death |
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a. |
County: Haywood County |
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b. |
Township: Waynesville, N.C. |
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c. |
City or town: Rural |
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d. |
Street, hospital or institution: blank |
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e. |
Length of stay in hospital or institution: 0; in this community: Two weeks |
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| 2. |
Home (usual Residence) |
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a. |
State: N.C. |
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b. |
county: Mecklenburg |
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c. |
City or town: Charlotte |
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d. |
Street or R.F.D.: 819 Sunnyside Avenue |
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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: Jake F. Newell |
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b. |
If veteran name war: 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 husband or wife: Francis B. Newell |
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c. |
Age of husband or wife if alive: 60 years |
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| 7. |
Birthdate of deceased: February 15th, 1869 |
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| 8. |
Age: 76 years, 5 months, 24 days |
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| 9. |
Birthplace: Cabarrus Co., N.C. |
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| 10. |
Usual Occupation: Lawyer |
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| 11. |
Industry or business: Legal |
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| 12. |
Father's Name: William Neweel |
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| 13. |
Father's Birthplace: Cabarrus Co., N.C. |
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| 14. |
Mother's maiden name: Caroline Hudson |
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| 15. |
Mother's birthplace: Cabarrus Co., N.C. |
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| 16. |
a. |
Informant;s Signature: Mrs. Jake F. Newell |
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b. |
Address: 819 Sunny Side Avenue, Charlotte, N.C. |
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| 17. |
a. |
Burial, cremation, removal: Removal |
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b. |
Date thereof: 8/8/45 |
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c. |
Cemetery: Boger's Chapel Cemetery |
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d. |
Location: Rural Rt. Concord, N.C. |
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| 18. |
a. |
Funeral Director: Garrett Funeral Home |
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b. |
Address: Waynesville, N.C. |
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| 19. |
a. |
Filed: 9-3-1945 |
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b. |
Registrar: Mrs. G.C. Davis |
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| 20. |
Date of Death: August 9th, 1945 at 12:10am |
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| 21. |
I certify that death occurred on the date above stated: that I attended deceased from Aug. 8, 1945 to Aug. 9, 1945 and that I last saw him alive on Aug. 8, 1945.
Immediate cause of death: acute dilitation of heart, due to Paroxysural Lachycardia attacks |
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| 22. |
blank |
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| 23. |
a. |
Signature: Sam L. Thurgfield, M.D. |
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b |
Address: Waynesville, N.C. |
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c. |
Date signed: 8/9/45 |