| 1. PLACE of
DEATH
County of: Newberry Township of (or) city of: Newberry Home address: R.F.D. 3 |
Standard Certificate of Death State of South Carolina Bureau of Vital Statistics State Board of Health Registration District No. 34a (No-----St.;------Ward) If death occurred in a Hospital or institution give its NAME instead of street and number Newberry Hospital
|
File No.- For State Registrar Only
Registered No.(for use of Local Registrar) | |
| 2. FULL NAME: Charles Bluford Bishop Residence: In City---Yrs.---Mth---Days--- | |||
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Personal and Statistical Particulars |
Medical Certificate of Death | ||
| 3.
Sex: M 4. Color or Race: W
5. Single/Married/Widowed/Divorced: married, Minnie Elizabeth Pitts |
21. DATE OF DEATH (Mth/Day/Yr): Sept 10, 1945 | ||
| 6. Date of Birth
(Mth/Day/Yr):
Jan 15, 1864
|
22. I Hereby Certify, That I attended deceased from Aug 20, 1945 to Sept 10, 1945; last saw him alive on Sept 10, 1945, death is said to have occurred on the date stated above, at ---am/pm. | ||
| 7. Age: Years 81 Months---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: Prostatic enlargement with urinary retention, pneumonia. | ||
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OCCUPATION 8. Trade, profession or particular kind of work done, as spinner, sawyer, bookeeper, etc: farmer. 9. Industry or business in which work was done, as silk mill, saw mill, bank, etc:-----. 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 none. Date of ---. What test confirmed diagnosis? ---. Was there an autopsy? no | ||
| 12. BIRTHPLACE (city or town): Newberry State or Country: SC | |||
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FATHER 13. NAME: Hilliard Bishop 14. BIRTHPLACE (city or town): Newberry State or Country: SC
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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:--- | ||
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MOTHER 15. MAIDEN NAME: Annie Dickert 16. BIRTHPLACE (city or town): Newberry State or Country: SC |
24. Was disease or injury in any way
related to occupation of deceased:---. If so, specify--.
Signed: E. H. Moore Address: Newberry, SC | ||
| 17. Informant/Address: Mrs. C. B. Bishop, Newberry, SC | |||
| 18. BURIAL CREMATION OR REMOVAL: Place Trinity Church, Date Sept 12, 1945 | |||
| 19. UNDERTAKER/ADDRESS: Leavell Funeral Home | |||
| 20. FILED: Sept 24, 1945, Mrs. A.H. Counts | |||
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