1. |
Place of Death |
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a. |
County: Lee |
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b. |
Township: blank |
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c. |
Length of stay: blank |
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d. |
City or town: Lanford; Is place of death within city limits? yes |
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e. |
Hospital or institution: Lee Co. Hospital |
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2. |
Usual Residence |
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a. |
State: N.C. |
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b. |
County: Lee |
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c. |
City or town: Lanford; Is place of residence in city limits? Yes; On a farm? No |
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d. |
Street address: 208 Makepeace St. |
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3. |
Name of deceased: Alonzo Jackson Bost |
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4. |
Date of Death: Aug. 4, 1962 |
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5 |
Sex: Male |
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6. |
Color or Race: White |
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7. |
widowed |
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8. |
Date of Birth: April 14, 1884 |
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9. |
Age: 78 years |
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10. |
a. |
Usual occupation: Power Construction |
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b. |
C.P. & L. Co. |
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11. |
Birthplace: Cabarrus Co. |
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12. |
Citizen of what country: USA |
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13. |
Father's name: Don't know |
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14. |
Mother's maiden name: Don't know. |
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Name of Husband or wife: Flossie Harrington |
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15. |
Was deceased ever in U.S. Armed Forces? No. |
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16. |
Social Security No.: blank |
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17. |
Informant's Name and Address: Bill Bost - Sanford, N.C. |
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18. |
a. |
Immediate Cause of death: Cardiac Failure, duration: 2-3 wks |
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b. |
due to Arterissclerotis coronary artery disease, duration: 6-8 years |
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c. |
due to Cardiac decompensetion |
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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 June 1962 to Aug. 4, 1962, and last saw him alive on Aug. 4/62. Death occured at _________ on the date stated above; and to the best of my knowledge from the causes stated. |
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22. |
a. |
Signature: U.R. Hartman, M.D. |
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b. |
Address: Sanford, N.C. |
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c. |
Date signed: 8/29/62 |
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23. |
a. |
Burial, cremation, removal: Burial |
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b. |
Date: Aug. 5, 1962 |
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c. |
Name of cemetery or crematory: Poplan Springs |
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d. |
Location: Lee Co., N.C. |
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24. |
Date rec'd by local reg.: 8-30-62 |
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25. |
Registrar's signature: O. Daniel Garmin |
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26. |
a. |
Funeral director: Rogers Funeral Home |
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b. |
Address: Sanford, N.C. |