| 1. |
Name: Otis Fred Frye |
| 2. |
Date of Death: September 29, 1970 |
| 3. |
Sex: Male |
| 4. |
Color or Race: White |
| 5. |
State of Birth: NC; County: Iredell |
| 6. |
Date of Birth: 12-31-1892 |
| 7. |
Age: 77 |
| 8. |
Place of Death: a) County: Iredell; b) City/Town: Statesville; c) Iredell Memorial Hospital d) Inside city limits. |
| 9. |
Usual Residence: a) State: N.C. b) County: Iredell c) City/Town: Statesville d)address: 1651 Forest Drive e) inside city limits |
| 10 |
Widowed |
| 11 |
surviving Spouse: Blank |
| 12. |
Citizen of USA |
| 13. |
Social Security Number: Blank |
| 14. |
Usual Occupation: Self Employed |
| 15. |
Father's Name: Avery Frye |
| 16. |
Mother's Maiden Name: Margaret Bollinger |
| 17. |
Informant's Name: Mrs. Walter Campbell, 1651 Forest Drive, Statesville, NC |
| 18. |
Cause of Death: a) Myocardial Infarction (15min.) b) Asteriosclerotic Heart Disease; c) Generalized Arteriosclerosis. |
| 19. |
Other significant Conditions: 1) Cerebral Vascular Accident 2) Fractured Hip |
| 20. |
Blank |
| 21. |
Certification: I attended the deceased from 1958 to 9-29-1970 and last saw him alive on 9-29-1970. Death occurred at 11:25a.m. on the date stated above and in my opinion from the causes stated. |
| 22. |
blank |
| 23. |
Signature of Certifier: Harry G. Waller, M.D. Date: 9-30-70; Statesville, NC |
| 24. |
Burial, 10-1-70; Rose Chapel Meth. Ch. Cem, Iredell Co., NC |
| 25. |
Funeral Home: Bunch Funeral Home, Statesville, NC. |
| 26. |
Signature of Funeral Director: Joe H. Troutman, License 1882 |
| 27 |
Date rec'd by local reg: 9-30-70 |
| 28. |
Signautre of Registrar; Signed but not legible |
| 29 |
Signature of Embalmer: Joe H. Troutman License No. 1044 |
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