| Registration Dist, No | 37-04 |
| Certificate Number | 106 |
| Home (usual residence) of Deceased | |
| State | NC |
| County | Gates |
| City or Town | Gatesville |
| Street or RFD | Rt 1 |
| Is place of residence in corporate limits? | No |
| If foreign born, how long in USA? (years) | |
| Place of death | |
| County | Gates |
| Township | Hunters Mill |
| City or town | Gatesville, NC |
| Street, Hospital or Institution | |
| Length of stay in hosptial or Institution | |
| In this community (yrs. mos, or days) | 79 |
| Full Name | Ann Norfleet Ballard |
| If Veteran, Name War | |
| Social Security Number | |
| Sex | Female |
| Color or race | Col |
| Single, Married, Widowed or Divorced | Married |
| Name of husband or wife | Anderson Ballard |
| Age of husband or wife if alive (years) | 85 |
| Birth date of deceased | 1862 |
| Age (Years-Months-Days) | 79yrs |
| If less than one day (hrs. mins) | |
| Birthplace | Gates Co., NC |
| Usual Occupation | Housewife |
| Industry or Business | |
| Father's name | Unknown |
| Birthplace of father | |
| Mother's maiden name | Unknown |
| Birthplace of mother | |
| Date of death (Mon-day-year-time) | Sept. 8, 1941 |
| Physician attended to and from dates | 9-8-1941-9-8-1941 |
| Last Seen | 9-8-1941 |
| Immediate cause of death | Coronary Occlusion |
| Duration | 8hrs |
| Due to | |
| Due to | |
| Other conditions | |
| Major findings of operations | |
| Of Autopsy | |
| Accident, suicide, or homicide | |
| Date of occurance | |
| Where did this injury occur? | |
| Place of injury | |
| At work? | |
| Means of injury | |
| Doctors signature | T.L. Carter |
| Address | Gatesville, NC |
| Date signed | 9-9-1941 |
| Informants signature | Charlie Norfleet |
| Address | Gatesville, NC |
| Burial, cremation or removal | Burial |
| Date | Sept. 10, 1941 |
| cemetery | Grave |
| location | Gates Co., NC |
| Funeral director | C.G. Ellis |
| address | Gatesville, NC |
| Filed | Sept 10, 1941 |
| Registrar | J.W. Overman |
| Comments | |
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