South Carolina Genealogy Trails - Finding Ancestors Wherever Their Trails Led
contributed by Randy Butler

1.  PLACE of DEATH

County of: --

Township of (or) city of: --

Home address:  Green St. Newberry, SC

 

Standard Certificate of Death

State of South Carolina

Bureau of Vital Statistics

State Board of Health

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 

# 09023


 

Registered No.(for use of Local Registrar)

2. FULL NAME:   Lucretia Milton Hilton                                                Residence: In City ---Yrs. ---Mth ---Days ---

Personal and Statistical Particulars

Medical Certificate of Death

3. Sex: 4. Color or Race: W

5. Single/Married/Widowed/Divorced: Widowed; m. John Butler, m. John E. Hilton  

21. DATE OF DEATH (Mth/Day/Yr)August 6, 1945

 

6. Date of Birth (Mth/Day/Yr): Aug. 23, 1864

 

 

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  81yr 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:  Congestive Heart Failure,  Embolism of pophteal.

OCCUPATION

8. Trade, profession or particular kind of work done, as spinner, sawyer, bookeeper, etc: retired.

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: old age.

Name of operation ----. Date of ---.

What test confirmed diagnosis? ---. Was there an autopsy?--

12. BIRTHPLACE (city or town):    Newberry                     State or Country: SC

FATHER

13. NAME:  Milton Longshore

14. BIRTHPLACE (city or town) Newberry, State or Country: 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 NAMESallie Senn

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: ----

Address: ----

17. Informant/AddressMrs. Sallie Norris, Newberry, SC
18. BURIAL CREMATION OR REMOVAL: Place: Rosemont Cem. , Date: August 7, 1945
19. UNDERTAKER/ADDRESS Leavell Funeral Home, Newberry, SC
20. FILED:

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