GROSS SARTOR Mary Elizabeth Catherine "Lizzie"

• Individual
• Ancestors
• Descendants
• Relationship
• Timeline
• Family
• Suggest

«Prev 1 2 3 4 Next»     » Slide Show

Death Certificate
SARTOR SHELTON DAVIS Pearl Wilma
25 March 1970

[editorial comment]
E893X
66
042-11-1 042-00
Certificate of Death
State File No.: [stamp] 16820
State of Texas
1. Place of Death: a. County: Coleman
b. City or Town or Precinct No: Precinct #4
c. Length of Stay (in this place): 63 years
d. Full Name of Hospital or Institution (If not hospital, give street address): 3 miles south of Goldsboro
e. Is place of death inside city limits? No
2. Usual Residence (Where deceased lived.)
a. State: Texas
b. County: Coleman
c. City or Town: Precinct #4
d. Street Address: 3 miles south of Goldsboro
e. Is residence inside city limits? No
f. Is residence a farm? Yes
3. Name of Deceased: Pearl Wilma Davis
4. Date of Death: March 25, 1970
5. Sex: Female
6. Color or Race: White
7. Married, Never Married, Widowed or Divorced: Widowed
8. Date of Birth: Nov. 3, 1889
9. Age, Years, Months, Days, If less than 1 Day Hours, Min: 80 years
10a. Usual Occupation: Housewife
10b. Kinda of Industry or Business: Home
11. Birthplace (state or country): Willcoxen, [Wilcox Co] Alabama
12. Citizen of what Country? U.S.A
13. Father's Name: J. Y. Sarter
14. Mother's Maiden Name: L. C. Gross
15. Was Deceased Ever in U.S. Armed Forces, (Yes, no, or unknown, If yes, give war or dates of service): No
16. Social Security No.: unknown
17. Informant's Signature: Mrs. Addie Bodine Daughter
Medical Certification
18. Cause of Death, Enter only one cause per line for a, b, c
I. Disease or Condition Directly Leading to Death *(This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death.
Immediate Cause (a) Severe burns resulting from
Due to (b) accidentally catching clothes on fire
II. Other Significant Conditions, Conditions contributing to the death but not related to the disease or condition causing death.: [blank]
19. Was autopsy performed? No
20. Accident, Suicide, Homicide…: Accident
20b. Describe how injury occurred: Clothes cought [sic] on fire from heater resulting in fatal burns
20c. Time of Injury: 8:15 A.M. 3-25-1970
20d. Injury Occurred: not while at work
20e. Place of Injury: residence
20f. City, town or location: 3 miles South of Goldsboro
21. I hereby certify that I attended the deceased from: seen after death only
Death occurred at 8:15 A.M., on the date stated above, and to the best of my knowledge, from the causes stated.
22a. Signature: Walter C. Holt, J.P
22b. Address: County Courthouse Coleman, Texas
22c. Date Signed: 3/27/70
23a. Burial, Cremation, Removal: Burial
23b. Date: Mar. 27, 1970
23c. Name of Cemetery or Crematory: Atoka Cemetery
23d. Location: Novice (Coleman Co) Texas
24. Funeral Director's Signature: Stevens Funeral Home / Den Freeman #5856
25a. Register's File No: 51
25b. Date Rec'd by Local Registrar: March 30, 1970
25c. Registrar's Signature: Glum Thumar
[stamp] Texas Department of Health, Rec'd Apr 20 1970, Bureau of Vital Statistics
[end]

«Prev 1 2 3 4 Next»     » Slide Show