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Standard Certificate of Death State of South Carolina Bureau of Vital Statistics State Board of Health 1. PLACE of DEATHCounty of: Newberry Township of (or) city of: Newberry Home address: -- Registration District No. -- (No -- St.; -- 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) |
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| 2. FULL NAME: George Elton Norris Residence: In City---Yrs.---Mth---Days--- | |
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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): October 14, 1932
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| 6. Date of Birth
(Mth/Day/Yr): July 20,
1890 |
22. I Hereby Certify, That I attended deceased from ---, 19-- to ---, 19--; last saw him alive on 13 October 1932 death is said to have occurred on the date stated above, at ---am/pm. |
| 7. Age: 42 Years, 2 Months, 24 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: Lobar Pneumonia Date of Onset: October 5, 1932 |
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OCCUPATION 8. Trade, profession or particular kind of work done, as spinner,
sawyer, bookeeper, etc: Spinning room, mill
work 10. Date deceased last worked at this occupation (Mth & Yr): October 3, 1932 11. Total time (years) spent in this occupation: 25 yrs |
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, South Carolina | |
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FATHER 13. NAME: Wilson Abner Norris 14. BIRTHPLACE (city or town): --- State or
Country:
Mississippi |
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: Mattie Reed 16. BIRTHPLACE (city or town): --- State or Country: Newberry Co, South Carolina |
24. Was disease or injury in any way
related to occupation of deceased:---. If so, specify--.
Signed: John K. Wicker Address: ---- |
| 17. Informant/Address: W.A. Norris | |
| 18. BURIAL CREMATION OR REMOVAL: Place: West End Cemetery Date: October 15, 1932 | |
| 19. UNDERTAKER/ADDRESS: ? and Son, Newberry , South Carolina | |
| 20. FILED: | |
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