Death Certificate of Hale, Levy

Narrative summary of the form data:

Levy Hale, a 73-year-old male farmer, was born about 1843 in Sampson Co.
to John Hale and unknown mother. He was married and resided in Mt. Olive
R.F.D., Warsaw Township, Duplin Co. He died of lobar pneumonia on 22 Mar
1925 in Duplin Co. and was buried there on 23 Mar 1925.

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| Field                                                      | Value                                                                                           |
|------------------------------------------------------------|-------------------------------------------------------------------------------------------------|
| 1 PLACE OF DEATH                                           | Duplin                                                                                          |
| Township                                                   | Warsaw                                                                                          |
| City                                                       | Mt. Olive R.F.D.                                                                                |
| 2 FULL NAME                                                | Levy Hale                                                                                       |
| (a) Residence. No.                                         | (blank)                                                                                         |
| 3 Sex                                                      | Male                                                                                            |
| 4 Color or race                                            | White                                                                                           |
| 5 Single, Married, Widowed, or Divorced                    | Married                                                                                         |
| 6 Date of birth (month, day, and year)                     | Don't know                                                                                      |
| 7 Age                                                      | 73 years                                                                                        |
| 8 Occupation of deceased                                   | Farmer                                                                                          |
| (a) Trade, Profession, or particular kind of work          | Farmer                                                                                          |
| (b) General nature of industry, business, or establishment | (blank)                                                                                         |
| (c) Name and address of employer                           | (blank)                                                                                         |
| 9 Birthplace (city or town, State or country)              | Sampson Co.                                                                                     |
| 10 Name of Father                                          | John Hale                                                                                       |
| 11 Birthplace of Father (city or town, State or country)   | Sampson Co.                                                                                     |
| 12 Maiden Name of Mother                                   | Don't know                                                                                      |
| 13 Birthplace of Mother (city or town, State or country)   | (blank)                                                                                         |
| 14 Informant                                               | (blank)                                                                                         |
| (Address)                                                  | (blank)                                                                                         |
| 15 Filed                                                   | 25 Mar 1925                                                                                     |
| Registrar                                                  | A. H. Whitfield                                                                                 |
| 16 Date of Death (month, day, and year)                    | 22 Mar 1925                                                                                     |
| 17 I HEREBY CERTIFY...                                     | Attended from Mar 12,1925toMay22,1925;lastseenaliveonMay22,1925;deathoccurredonMay22,1925at12h. |
| THE CAUSE OF DEATH                                         | Lobar Pneumonia                                                                                 |
| (duration)                                                 | 10 days                                                                                         |
| Contributory (Secondary)                                   | None                                                                                            |
| (duration)                                                 | (blank)                                                                                         |
| 18 Where was disease contracted if not at place of death   | (blank)                                                                                         |
| Did an operation precede death?                            | (blank)                                                                                         |
| Date of                                                    | (blank)                                                                                         |
| Was there an autopsy?                                      | (blank)                                                                                         |
| What test confirmed diagnosis?                             | (blank)                                                                                         |
| Signed                                                     | C.C. Henderson, M.D.                                                                            |
| (Address)                                                  | East Lincolnton                                                                                 |
| 19 Place of Burial, Cremation, or removal                  | Duplin Co.                                                                                      |
| Date                                                       | 23 Mar 1925                                                                                     |
| 20 Undertaker                                              | J.H. Newkirk & Co.                                                                              |
| (Address)                                                  | Mt. Olive, N.C.                                                                                 |
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