Death Certificate of Smith, William Robert

William Robert Smith was born on 10 Mar 1866 in Northampton County to
William Smith and Outland. He died on 9 Sep 1931 in Pendleton, Kirby
Township, Northampton County, North Carolina. He was a 65-year-old white
male farmer who was married to Mary A. Smith at the time of his death.
The cause of death was myocarditis after suffering for 9 3/4 months. He
was buried at his residence on 10 Sep 1931. The attending physician was
D. B. Z. Peebles, M.D. from Conway, N.C.

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| ID | Section                              | Field Description                  | Value                  |
|----|--------------------------------------|------------------------------------|------------------------|
| 1  | Place of Death                       | County                             | Northampton            |
| 2  | Place of Death                       | State                              | NC                     |
| 3  | Place of Death                       | Township                           | Kirby                  |
| 4  | Place of Death                       | City or Village                    | Pendleton              |
| 5  | Full Name                            | Full Name                          | William Robert Smith   |
| 6  | Personal and Statistical Particulars | Sex                                | Male                   |
| 7  | Personal and Statistical Particulars | Color or Race                      | White                  |
| 8  | Personal and Statistical Particulars | Marital Status                     | Married                |
| 9  | Personal and Statistical Particulars | Spouse’s Name                      | Mary A. Smith          |
| 10 | Personal and Statistical Particulars | Date of Birth                      | Mar 10, 1866           |
| 11 | Personal and Statistical Particulars | Age                                | 65                     |
| 12 | Personal and Statistical Particulars | Occupation                         | Farmer                 |
| 13 | Personal and Statistical Particulars | Industry/Business                  | Farming                |
| 14 | Personal and Statistical Particulars | Birthplace (City or Town)          | Northampton Co.        |
| 15 | Personal and Statistical Particulars | Father's Name                      | William Smith          |
| 16 | Personal and Statistical Particulars | Father's Birthplace                | Northampton Co.        |
| 17 | Personal and Statistical Particulars | Mother's Maiden Name               | Outland                |
| 18 | Personal and Statistical Particulars | Mother's Birthplace                | Northampton Co.        |
| 19 | Informant                            | Name                               | Mary A. Smith          |
| 20 | Informant                            | Address                            | Pendleton, NC          |
| 21 | Burial, Cremation, or Removal        | Place                              | Residence              |
| 22 | Burial, Cremation, or Removal        | Date                               | Sept 10, 1931          |
| 23 | Undertaker                           | Name                               | Ruffin & Turner        |
| 24 | Undertaker                           | Address                            | (Not specified)        |
| 25 | Filed                                | Date                               | 9/15/31                |
| 26 | Medical Certificate of Death         | Date of Death                      | Sept 9, 1931           |
| 27 | Medical Certificate of Death         | Attending Physician Last Saw Alive | 9/8/31                 |
| 28 | Medical Certificate of Death         | Time of Death                      | 2 a.m.                 |
| 29 | Medical Certificate of Death         | Principal Cause of Death           | Myocarditis            |
| 30 | Medical Certificate of Death         | Duration of Principal Cause        | 9 3/4 months           |
| 31 | Medical Certificate of Death         | Contributory Cause                 | (Blank)                |
| 32 | Medical Certificate of Death         | Name of Operation                  | (Blank)                |
| 33 | Medical Certificate of Death         | Autopsy                            | (Blank)                |
| 34 | Medical Certificate of Death         | Accident, Suicide, or Homicide     | No                     |
| 35 | Medical Certificate of Death         | Signature of Physician             | D. B. Z. Peebles, M.D. |
| 36 | Medical Certificate of Death         | Address of Physician               | Conway, N.C.           |
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