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Death Certificate of Minnie Lee Butler

Standard Certificate of Death State of South Carolina

Bureau of Vital Statistics State Board of Health

1.  PLACE of DEATH

County of:  Greenwood

Township of (or) city of:  --

Home address:  South Greenwood

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
2370

Registered No. (for use of Local Registrar)

2. FULL NAME: Minnie Lee Butler                                   Residence: In City---Yrs.---Mth---Days---

Personal and Statistical Particulars

Medical Certificate of Death

3. Sex: Female     4. Color or Race: White

5. Single/Married/Widowed/Divorced: Single

21. DATE OF DEATH (Mth/Day/Yr)February 3, 1925 

 

6. Date of Birth (Mth/Day/Yr)April 3, 1903, South Carolina

 

 

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  --, 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:  Post typhoidal (toxemia); typhoid fever

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):                        State or Country:  South Carolina

FATHER

13. NAME:  Ned  Butler 

14. BIRTHPLACE (city or town):----   State or Country:  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 NAMEAnn Hastings

16. BIRTHPLACE (city or town):---  State or Country:   South Carolina

24. Was disease or injury in any way related to occupation of deceased:---.  If so, specify--.

Signed:----

Address:----

17. Informant/AddressNed Butler, South Greenwood, South Carolina
18. BURIAL CREMATION OR REMOVAL: Place:  Greenwood        Date:  February 24, 1925
19. UNDERTAKER/ADDRESSH. B. Ellis, Greenwood Co, South Carolina
20. FILED:

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