Death Certificate for Mary Katherine
DeHardt - contributed by Madena
Thomason-Whitesell
| Registration Dist. No: 38-a Registrar's No: Birth No.: |
Standard Certificate of Death Division of Vital Statistics - State Board of Health State of South Carolina |
State File No.: 50-005125 | |||||||
| 1. PLACE OF DEATH: (a) County: Richland |
2. USUAL RESIDENCE: (where
deceased lived. If institution; residence before admission)
(a) State: SC (b) County: Richland | ||||||||
| (b) City or town (if
outside corporate limits, write Rural and give township): Columbia (c) Full name of hospital or institution (if not in hospital or institution, give street address or location):: S.C. Baptist Hospital |
(c) City or town (if outside corporate limits, write Rural and give township): Columbia | ||||||||
| (d) Length of stay: In hospital or institution: | (d) Street Address (if
rural, give location): 1613 Sumter
St.
(e) If foreign born, how long in U.S.A.? | ||||||||
| 3(a) NAME OF DECEASED: Mrs. Mary Katherine DeHart (DeHardt)
3(b) If veteran, name war 3 (c) Social Security No. | |||||||||
| 4. Sex: F
5. Color or race: W
|
6(a). Married, never married, widowed,
divorced: W
6(b) Name of husband or wife 6(c) Age of husband or wife if alive -- years |
7. Birth date of deceased: Dec. 6, 1854
|
8. Age (in years last birthday): 96 years 3 months 19 days |
9. Birthplace: Newberry Co., SC
| |||||
| 10. Usual occupation: at home | 11. Industry or business: | ||||||||
| 12. Father's name: Mr. Thomason
13. Birthplace: |
14. Mother's maiden name: Mrs. Harriet Thomason
15. Newberry Co., SC |
16(a). Informant: W. D. Shealy
16(b) Address: | |||||||
| 17(a) Burial, cremation, or removal Burial (b) Date therof 3-20-50 (c) Place; burial or cremation Newberry | 18 (a) Signature of funeral director M E. Elgin (?) (b) Address Newberry | 19(a) 5-19-50 (b) Chas. R. Sloan, M.D. | |||||||
|
Medical Certification |
|||||||||
| 20. Date of death: Month March day 19
year 1950 hour 5:00
minute 20
21. I herby certify that I attended the deceased from Sept 17, 1949 to March 19, 1950, that I last saw her alive on March 18, 1950, and that death occurred on the date and hour stated above. Immediate cause of death: Broncho Pneumoniadue to Fracture of Femur Rt. due to Other significant conditions (include pregnancy within three months of death) Major findings: Of operations Of autopsy: NO | |||||||||
| 22. If death was due to external causes,
fill in the following: (a) Accident, Suicide, Homicide (specify): Accident |
(b) Date of occurrence: Sept 19, 1949 | (c) Where did injury occur? Columbia, SC | |||||||
| (d) did injury occur in or abut home, on farm, in industricl place, in public place: Home | While at work? | (e) Means of injury: Fall | |||||||
| 23. Signature: L. J. Braunson (M.D. or other) | Address: 1726 Hampston St. | Date signed: 4-1-50 | |||||||
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