Burke County, NC - Vitals - Martha Jane Cook Childers, 1943

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Death Certificate for Martha Jane Cook Childers

North Carolina State Board of Health   
Bureau of Vital Statistics
Certificate of Death              
Registration Dist. No. 12-00  
Certificate No. 1

1.   Place of Death:
(a) County  Burke (b) Township  Drexel
2. Home (Usual Residence) of Deceased:
(a) State  NC  (b) County  Burke  (c) City or Town  Drexel
(f) Is place of residence in corporate limits?  No
3. (a) Full Name  Martha Jane Childers
4. Sex  F   
5. Color or Race  W
6. Single, Married, Widowed or Divorced,  Wid
8. AGE:   Years  94  Months  2   Days  11
9. Birthplace   Burke County
10. Usual occupation  House work
FATHER
12. Name   Jesse Cook
13. Birthplace   Burke
16. (a) Informant's Signature  M.L. Childres
(b) Address   Worry NC
17 (c) Cemetery  Burke Co.
(d) Location Burke Co.
18 (a) Funeral Director  Kirksey & Co.
(b) Address  Morganton NC
19 (a) Filed  5-3-1943  (b)  J.L. Page  Registrar
MEDICAL CERTIFICATION
20. Date of Death   1-11-1943, at 2 pm
21. I certify that death occured on the date above stated: 
that I attended deceased from   2/8/1943  to 2/8/1943
and that I last saw her alive on  2/8/1943
Immediate cause of death  (?) informaties of old age
23.  Signature   F.O. Foard  M.D.
Address     Valdese

Certificate number 401 Burke County courthouse