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