North Carolina State Board of Health
Office of Vital Statistics
Certificate of Death
Stamped: May 20, 1974
| Registration District No: 85-00 |
Registrar's Certificate No: |
14925 |
|
|
Name of Deceased: Katie Freeze Riely
Dateof Death: April 26, 1974
Sex: Female
Color/Race: White
State of Birth: North Carolina
Date of Birth: August 10, 1898
Age: 75 Years
Place of Death: County: Stokes; City/Town: Walnut Cove; Hospital/Institute: Walnut Cove Nursing Care Center; Inside City Limits
Usual Residence: State: North Carolina; County: Cabarrus; City: Concord; Street Address: Route 2; Not in city Limits.
Widowed
Citizen of USA
Occupation: Housewife
Father's Name: J. Mack Freeze
Mother's Maiden Name: Mattie Wright
Informant's Name/Address: Mrs. W.O. Overcash, Route 2, Concord, N.C. - Daughter
Death Caused by: Aortic Stenosis due to Rheumatic Heart Disease; duration 2 years +.
Other significant Conditions: Fracture, right hip, old; Cataract.
No Autopsy
Certification - Physician: I attended the deceased from June 1973 to 26 Apr 1974 and last saw her alive on 20 Apr 9174 death occurred at 9:40AM on teh date stated avove and in my opinion for the causes stated.
Signature of Cerifier: ?.J. Fowler, M.D.; Date: 7 MAy 74; Address: Walnut Cove, N.C.
Burial: Date: 4-28-74
Cemetery: St. Enoch Luth. Ch. Cem.; Location: Kannapolis, N.C.
Funeral Home: Lady's Funeral Home, Kannapolis, N.C.
Signature of Funeral Director: G.L. Coggins, License No. 95
Date Red'd by Local Reg.: 5/9/74
Signature of Registrar: J.S. Taylor, M.D.
Signature of Embalmer: G.L. Coggins, License No. 84 |
Transcribed from photocopy of original document. |
