1 |
Place of Death |
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a. |
County: Harnett |
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b. |
Township: Duke |
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c. |
City or Town: Erwin, N.C. |
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d. |
Full Name of hospital or institution: blank |
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e. |
Length of stay in hospital or institution: blank |
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2. |
Full Name: Mrs. Margaret Grace Coley Bost |
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a. |
residence: Erwin, N.C. |
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3. |
Sex: female |
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5. |
Color or Race: White |
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6. |
married. If married, husband or wife: E.H. Bost |
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7. |
Date of Birth: Dec. 10, 1878 |
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8. |
Usual Occupation: Domestic |
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| 9 - 11: blank |
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12. |
Birthplace: Greenwood, Ind. |
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13. |
Father's Name: Jas. H. Coley |
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14. |
Birthplace: North Carolina |
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15. |
Mother's Maiden Name: Mary Margaret Mock |
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16. |
Birthplace: Davie County, N.C. |
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17. |
a. |
Informant: Dr. G.L. Hooper (address) Erwin, N.C. |
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18. |
a |
Burial, cremation, removal; Place: Durham, N.C. Date: Feb. 3, 1935 |
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19. |
Undertaker: R.L. Cromartie, Jr. (address) Dunn, N.C. |
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20. |
a. |
filed: Feb. 6, 1935 |
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b. |
Registrar's Signature: Wm. R. Holt |
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| 21. |
Date of death: Feb. 2, 1935 |
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22. |
I hereby certify that I attended deceased from Jan. 31st 1935 to Feb. 2nd, 1935. I last saw her alive on Feb. 2nd, 1935, death is said to have occurred on the date stated above, at 9am.
The principal cause of death: Auricular Fribrilation with partial heart desease. |
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23. |
blank |
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23. |
a |
Signature: Wm. P. Holt, M.D. |
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b. |
Address: Erwin, N.C. |
