|
PERSONAL
AND STATISTICAL PARTICULARS
|
3. SEX
F.
M. |
4.
COLOR OR RACE
White |
5.
. . .
Widow |
5a.
. . . WIFE of? George Deanhardt
6.
DATE OF BIRTH Don't
know
7.
AGE about 80 . . .
8-11.
OCCUPATION . . . Domestic
. . .
12.
BIRTHPLACE . . . S. C.
13.
[FATHER] NAME Andrew Wilson
14.
[FATHER] BIRTHPLACE . . . S.
C.
15.
[MOTHER] MAIDEN NAME Missouri
Nichols
16.
[MOTHER] BIRTHPLACE . . . S. C.
17.
INFORMANT W. B. Deanhardt
(Address)
Belton,
S.
C.
18.
BURIAL, CREMATION, OR REMOVAL
Place
Belton Cem. Date May 27th, 1936
19.
UNDERTAKER Cox Furn. Co.
(Address)
Belton, S. C.
20.
FILED [DATED 10 APRIL 1936 AND SIGNED] |
MEDICAL
CERTIFICATE OF DEATH
21.
DATE OF DEATH May 26,
1936
22.
. . . cause of death . . . Hx
Hypertension
Cardiovascular
. . . Contributory . . . Arterosclerosis
. .
. . .
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