| 1. PLACE of
DEATH
County of: Newberry Township of (or) city of: Newberry Home address: Newberry
|
Standard Certificate of Death State of South Carolina Bureau of Vital Statistics State Board of Health Registration District No. 34-A (No Fair St.; 1st Ward) If death occurred in a Hospital or institution give its NAME instead of street and number
|
File No.- For State Registrar Only
Registered No.(for use of Local Registrar) | |
| 2. FULL NAME: Andrew Cornelius Thomasson Residence: In City---Yrs.---Mth---Days--- | |||
|
Personal and Statistical Particulars |
Medical Certificate of Death | ||
| 3. Sex: Male
4. Color or Race: White
5. Single/Married/Widowed/Divorced: Widowed |
21. DATE OF DEATH
(Mth/Day/Yr): May 31, 1940
| ||
| 6. Date of Birth
(Mth/Day/Yr): Nov. 23, 1855 |
22. I Hereby Certify, That I attended deceased from May 28, 1940 to May 31, 1940; last saw him alive on May 31, 1940, death is said to have occurred on the date stated above, at 9 am/pm. | ||
| 7. Age: 85 Years, 6 Months, 8 Days (If less than 1 day, ---hrs. or ----min.) | The principal cause of death and related
causes of importance in order of onset were as follows: Cerebral
Hemorrhage Date of onset: 82-aI | ||
|
OCCUPATION 8. Trade, profession or particular kind of work done, as spinner,
sawyer, bookeeper, etc: Retired 10. Date deceased last worked at this occupation (Mth & Yr): - 11. Total time (years) spent in this occupation: - |
Was this death due to pregnancy or to
childbirth? If so, sate which ----.
Contributory causes of importance not related to principal cause: ----. Name of operation ----. Date of ---. What test confirmed diagnosis? ---. Was there an autopsy?-- | ||
| 12. BIRTHPLACE (city or town): Newberry State or Country: Newberry County, South Carolina | |||
|
FATHER 13. NAME: Arnall (Arnold )Thomasson 14. BIRTHPLACE (city or town): --- State or Country: Newberry Co., SC |
23. If death was due to external causes
(violence) fill in also the following: Accident, suicide, or
homicide: ---. Date of injury --, 19--. Where did injury occur (city/town/state; industry, home, public place)? --- Manner of injury:--- Nature of injury:--- | ||
|
MOTHER 15. MAIDEN NAME: Harriette (Harriet) Suber 16. BIRTHPLACE (city or town): -- State or Country: Newberry , South Carolina |
24. Was disease or injury in any way
related to occupation of deceased: No. If
so, specify--.
Signed: J. H. McCullough Address: Newberry, SC | ||
| 17. Informant/Address: Mrs. F. G. Hartley (Maggie Thomasson, d/o Andrew), Aiken, SC | |||
| 18. BURIAL CREMATION OR REMOVAL: Place: Rosemont Date: June 2, 1940 | |||
| 19. UNDERTAKER/ADDRESS: Leavell Funeral Home, Newberry, SC | |||
| 20. FILED: June 10, 1940 | |||
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