Death Certificate of Corbett, James Samuel

James Samuel Corbett, son of James Corbett and Nancy Katherine Price,
was born 23 Aug 1884 in Johnston County, N.C. He died 20 Mar 1963 at
Kenly R-2 Dau. Home in Kenly, Johnston County, N.C. at age 78. He was a
farmer by occupation. His wife Alice Katherine Corbett preceded him in
death. The immediate cause of death was pneumonia, with stroke and
hypertension as antecedent causes. He was buried 21 Mar 1963 at Sardis
Baptist Church, Rt. 2, Smithfield, N.C.

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| ID   | Section                                 | Field Description                      | Value                                          |
|------|-----------------------------------------|----------------------------------------|------------------------------------------------|
| 1    | Registration                            | District No.                           | 57-00                                          |
| 2    | Registration                            | Certificate No.                        | 9578                                           |
| 3    | Place of Death                          | County                                 | Johnston                                       |
| 4    | Place of Death                          | Township                               | O'Neil                                         |
| 5    | Place of Death                          | Length of Stay (in la)                 | 24 hrs                                         |
| 6    | Place of Death                          | City or Town                           | Kenly                                          |
| 7    | Place of Death                          | Is Place of Death Within City Limits   | No                                             |
| 8    | Place of Death                          | Hospital or Institution                | Kenly R-2 Dau. Home                            |
| 9    | Usual Residence                         | State                                  | N.C.                                           |
| 10   | Usual Residence                         | County                                 | Johnston                                       |
| 11   | Usual Residence                         | City or Town                           | Smithfield                                     |
| 12   | Usual Residence                         | In City Limits?                        | No                                             |
| 13   | Usual Residence                         | Place of Residence                     | Route #2                                       |
| 14   | Name of Deceased                        | First                                  | James                                          |
| 15   | Name of Deceased                        | Middle                                 | Samuel                                         |
| 16   | Name of Deceased                        | Last                                   | Corbett                                        |
| 17   | Sex                                     | Sex                                    | Male                                           |
| 18   | Color or Race                           | Race                                   | White                                          |
| 19   | Marital Status                          | Married/Widowed/Divorced/Never Married | Married                                        |
| 20   | Date of Birth                           | Date of Birth                          | Aug. 23, 1884                                  |
| 21   | Age                                     | Age at Death                           | 78 yrs                                         |
| 22   | Usual Occupation                        | Occupation                             | Farmer                                         |
| 23   | Kind of Business/Industry               | Business/Industry                      | Farming                                        |
| 24   | Birthplace                              | Birthplace                             | Johnston Co., N.C.                             |
| 25   | Citizen of What Country                 | Citizenship                            | U.S.A.                                         |
| 26   | Father's Name                           | Father's Name                          | James Corbett                                  |
| 27   | Mother's Maiden Name                    | Mother's Maiden Name                   | Nancy Katherine Price                          |
| 28   | Name of Husband or Wife                 | Name of Spouse                         | Alice Katherine Corbett                        |
| 29   | Informant                               | Name and Address                       | James (pete) Corbett, Rt. #2, Smithfield, N.C. |
| 30   | Was Deceased Ever in U.S. Armed Forces? | Military Service                       | No                                             |
| 31   | Social Security No.                     | Social Security No.                    | None                                           |
| 32   | Cause of Death                          | Immediate Cause (a)                    | Pneumonia                                      |
| 33   | Cause of Death                          | Antecedent Causes (b, c)               | Stroke, Hypertension                           |
| 34   | Interval Between Onset and Death        | Pneumonia                              | 24 hrs                                         |
| 35   | Interval Between Onset and Death        | Stroke                                 | 3 wks                                          |
| 36   | Other Significant Conditions            | Other Conditions                       | Old Fracture, Left Hip, Bed Sores, Senility    |
| 37   | Was Autopsy Performed?                  | Autopsy                                | No                                             |
| 38   | Accident/Suicide/Homicide               | Accident/Suicide/Homicide              | No                                             |
| 39   | Time of Injury                          | Time of Injury                         | Not applicable                                 |
| 40   | Injury Occurred                         | Injury Occurred                        | Not applicable                                 |
| 41   | Place of Injury                         | Place of Injury                        | Not applicable                                 |
| 42   | City or Township                        | City/Township                          | Not applicable                                 |
| 43   | County                                  | County                                 | Not applicable                                 |
| 44   | State                                   | State                                  | Not applicable                                 |
| 45   | Attended from Date                      | Attended from                          | 10/8/62                                        |
| 46   | Attended to Date                        | Attended to                            | 3/20/63                                        |
| 47   | Last Saw Alive                          | Last Saw Alive                         | 3/20/63                                        |
| 48   | Death Occurred at                       | Time                                   | 8:30 a.m.                                      |
| 49   | Signature of Certifier                  | Name                                   | R. A. Ingle, M.D.                              |
| 50   | Address of Certifier                    | Address                                | Selma, N.C.                                    |
| 51   | Date Signed                             | Date Signed                            | 3/26/63                                        |
| 52   | Burial/Cremation/Removal                | Type                                   | Burial                                         |
| 53   | Date of Burial                          | Date                                   | 3-21-63                                        |
| 54   | Name of Cemetery or Crematory           | Cemetery                               | Sardis Bapt. Ch.                               |
| 55   | Location                                | Location                               | Rt. #2, Smithfield, N.C.                       |
| 56   | Funeral Director                        | Name                                   | Overby Funeral Home                            |
| 57   | Funeral Director Address                | Address                                | Smithfield, N.C.                               |
| 58   | Date Received by Local Registrar        | Date                                   | 3/26/63                                        |
| 59   | Signature of Registrar                  | Signature                              | J. B. O'Neal                                   |