| 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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