NOTE:  Sections 19 and 21 are blank and to save room, I just left them out. Section 19 concerns operation, I am assuming that is
for if they tried an operation before the person died and since it's blank, no operation was performed.  Section 21 concerns injury,
and since he didn't die of an injury that was also left blank.

Birth No. 132                                                    Bureau of Vital Statistics
                                Certificate of Death               176
Registration District                    Registrar's Certificate
No.:  12-00                                  No.:  (Blank)
________________________________________________________________________________________

1. Place of Death:    b. Township:               c. Length of                                      2. Usual Residence (where deceased lived.)
a. County:   Burke                       Stay (in this place): 2yrs, 1 mo., 21 dys           a. State:  NC             b. County:    Iredell
d. City or Town:  Morganton       Is Place of Death Within City                         c. City or Town:   Mooresville  WithinCity
                                                     Limits:     NO                                                                                                 Limits:  YES
Full Name of Hospital of Institution:    State Hopital at Morganton                      d. Street Address:               unknown
________________________________________________________________________________________

3. Name of Deceased:       a. (First)        b. (Middle)     c. (Last)                  4. Date of Death:    a. (Month) b. (Day) c. (Year)
                                                Henry            Taylor            Eller                                                            1               27          1953
5. Sex:          6. Race:          7. Marital Status:           8. Date of Birth:       9. Age:     Months:    Days:    Hours:     Mins.:
    Male          White               Married                            5-11-1866               86          8             16          Blank     Blank
10a. Usual Occupation:   10b. Business or Industry:    11. Birthplace:                                      12. Citizen of What Country:
          unknown                           (blank)                                    Wilkes County                                           (Blank)
13. Father's Name:              unknown                              14.  Mother's Maiden Name:             unknown
15. Was Deceased Ever in Armed Services:       16. Social Security No.      17. Informant's Name and Address:
           yes   Dates of Service:    unknown                       unknown                                          State Hospital Records
_________________________________________________________________________________________

                          18.  Medical Certification -- Cause of Death                                    Interval between onset and death:
I a.  Disease or condition directly leading to death:      Acute Cardiac Failure                              (Blank)
   b.  Antecedent Causes due to:          Chronic Congestive Heart Failure                                        (Blank)
   c.  Antecedent Causes due to:       Arteriosclerotic Heart Disease                                                (Blank)
II.    Other Significant Conditions:           Senile Pyschosis - Paranoid                         20: Autopsy:            NO
 
 

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