Certificate of Death

John Holliday Baker

Registration Dist, No 37-5473
Certificate Number 14
Home (usual residence) of Deceased  
State NC
County Gates
City or Town Haslett
Street or RFD  
Is place of residence in corporate limits?  
If foreign born, how long in USA? (years)  
Place of death  
County Gates Co., NC
Township Haslett
City or town  
Street, Hospital or Institution  
Length of stay in hosptial or Institution  
In this community (yrs. mos, or days)  
Full Name John Holliday Baker
If Veteran, Name War  
Social Security Number  
Sex Male
Color or race White
Single, Married, Widowed or Divorced Married
Name of husband or wife Ida Harrell Baker
Age of husband or wife if alive (years)  
Birth date of deceased  
Age (Years-Months-Days) 66yrs 8mos 15dys
If less than one day (hrs. mins)  
Birthplace Gates, NC
Usual Occupation Farming
Industry or Business  
Father's name Harrison Baker
Birthplace of father Gates, NC
Mother's maiden name Mary A. Ellers (Ellew?)
Birthplace of mother Gates Co., NC
Date of death (Mon-day-year-time) Nov. 22, 1924
Physician attended to and from dates  
Last Seen No physician
Immediate cause of death Died suddenly
Duration  
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  
Address  
Date signed  
Informants signature Ida Harrell Baker
Address Drum Hill, NC
Burial, cremation or removal Burial
Date Nov. 27, 1924
cemetery  
location  
Funeral director R.W. Baker
address Suffolk, VA
Filed  
Registrar L.W. Parker
Comments

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