| Registration Dist, No | 37-00 |
| Certificate Number | 3 |
| Home (usual residence) of Deceased | |
| State | NC |
| County | Gates |
| City or Town | |
| Street or RFD | RFD |
| Is place of residence in corporate limits? | No |
| If foreign born, how long in USA? (years) | |
| Place of death | |
| County | Gates |
| Township | Hall |
| City or town | Eure, NC |
| Street, Hospital or Institution | |
| Length of stay in hosptial or Institution | |
| In this community (yrs. mos, or days) | |
| Full Name | Serena Ballard |
| If Veteran, Name War | |
| Social Security Number | |
| Sex | F |
| Color or race | C |
| Single, Married, Widowed or Divorced | Married |
| Name of husband or wife | Heber Ballard |
| Age of husband or wife if alive (years) | 56yrs |
| Birth date of deceased | |
| Age (Years-Months-Days) | 60yrs 10mos |
| If less than one day (hrs. mins) | |
| Birthplace | Scotland Neck, NC |
| Usual Occupation | Domestic |
| Industry or Business | |
| Father's name | Smith |
| Birthplace of father | Unknown |
| Mother's maiden name | Unknown |
| Birthplace of mother | Unknown |
| Date of death (Mon-day-year-time) | July 17, 1947 11:30pm |
| Physician attended to and from dates | July 3, 1947-July 17, 1947 |
| Last Seen | July 17, 1947 |
| Immediate cause of death | Hypostatic pneumonia due to apoplexy |
| Duration | 2 dys |
| Due to | Hypertensive cardiac vascular disease |
| Due to | For 7 yrs |
| 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 | Parish B. Cleveland |
| Address | Gatesville, NC |
| Date signed | July 18, 1947 |
| Informants signature | L. Heber Ballard X (signed with mark) |
| Address | Eure, NC |
| Burial, cremation or removal | Burial |
| Date | |
| cemetery | Cross Cemetery |
| location | Eure, NC |
| Funeral director | A.L. Weaver |
| address | Winton, NC |
| Filed | 7-8-1947 |
| Registrar | P.B. Cleveland |
| Comments | |
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