Source
Transcription
1 Place of death
County Guilford Registration District No. (41-900 Certificate No. 288
Township High Point
City High Point, N.C. No. Burrus Memorial Hospital
2 Full Name Mrs. Juanita Rush Lassiter
Reisidence: No. Academy
3 Sex female
4 Color or race White
5 Single, Married, Widowed, or Divorced Married
5a HUSBAND of WIFE of Thomas Lassiter
6 Date of birth 1880
7 Age Years 57
Occupation
8 Trade, profession or particular kind of work done Housework
9 Industry or business in which wor was done own home
12 Birthplace North Carolina
Father
13 Name Harris Rush
14 Birthplace North Carolina
Mother
15 Maiden Name Fannie Hix
16 Birthplace North Carolina
17 Informant Thomas Lassiter, Asheboro, N.C.
18 Burial, Cremation or Removal
Place Asheboro, N.C. Date Oct. 14 1937
19 Undertaker Pugh’s Funeral HOme, Asheboro, N.C.
Medical Certification of Death
21 Date of death Oct. 12, 1937
22 I HEREBY CERTIFY, That I attended deceased from 9/28, 1937, to 10/12, 1937 I last saw her alive on 10/12, 1937, death is said to have occurred on the date stated above a 6 p.m.
The principal causes of death and related causes of importance in order of onset were as follows:
| Date of onset | |
|---|---|
| Pneumonia | 10/9 |
| Hyperthyroidism from toxic adenoma of thyroid | about 1935 |
Name of operation Thyroidectomy date of 10/8/37
What test confirmed diagnosis? Operation Was there an autopsy? No
24 Was disease or injury in any way related to occupation of deceased? No
(Signed) H.L Brockman, M.D.
High Point, N.C.
Notes
refersto::Juanita Rush refersto::Thomas E. Lassiter refersto::Calvin Harris Rush refersto::Frances Hix