Newberry County South Carolina Genealogy Trails

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Death Certificate of Herman Butler

Standard Certificate of Death State of South Carolina Bureau of Vital Statistics State Board of Health 1. PLACE of DEATH County of: Newberry Township of (or) city of: -- 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 22428 Registered No. (for use of Local Registrar)
2. FULL NAME: Herman Butler 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:	21. DATE OF DEATH (Mth/Day/Yr): October 13, 1918
6. Date of Birth (Mth/Day/Yr): April 10, 1918	22. I Hereby Certify, That I attended deceased from ---------, 19-- to ---, 19--; last saw h-- alive on ---, 19--, death is said to have occurred on the date stated above, at ---am/pm.
7. Age: Years---Months 6, Days 3 (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: Broncial Pneumonia following Influenza
OCCUPATION 8. Trade, profession or particular kind of work done, as spinner, sawyer, bookeeper, etc: -----. 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 ----. Date of ---. What test confirmed diagnosis? ---. Was there an autopsy?--
12. BIRTHPLACE (city or town): Newberry State or Country:
FATHER 13. NAME: J. (C) Butler 14. BIRTHPLACE (city or town): --- State or Country: Newberry Co, South Carolina	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: Belle Bowers 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:---- Address:----
17. Informant/Address: (O/An) E. (Dawhux), Prosperity, South Carolina
18. BURIAL CREMATION OR REMOVAL: Place: St. Lukes Date: October 14, 1918
19. UNDERTAKER/ADDRESS: Eva Counts, Prosperity, South Carolina
20. FILED:

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