Lettie Beatrice VIRT (BOLIN) Death Certificate

STATE OF TEXAS

CERTIFICATE OF DEATH

STATE FILE NO. [blank]

1. PLACE OF DEATH

a. COUNTY: Cameron

b. CITY OR TOWN: Harlingen

c. LENGTH OF STAY: 43 years

d. NAME OF HOSPITAL OR INSTITUTION: Valley Baptist Hospital

e. IS PLACE OF DEATH INSIDE CITY LIMITS? Yes

2. USUAL RESIDENCE

a. STATE: Texas

b. COUNTY: Cameron

c. CITY OR TOWN: Harlingen

d. STREET ADDRESS: 2 Mile W. St. Highway 83

e. IS RESIDENCE INSIDE CITY LIMITS? No

f. IS RESIDENCE ON A FARM? No

3. NAME OF DECEASED: Lettie Beare Grindle

4. DATE OF DEATH: January 26, 1973

5. SEX: Female

6. COLOR OR RACE: White

7. Widowed

8. DATE OF BIRTH: March 31, 1888

9. AGE: 84

10a. USUAL OCCUPATION: Housewife

10b. KIND OF BUSINESS OR INDUSTRY: Home

11. BIRTHPLACE: Paragon, Indiana

12. CITIZEN OF WHAT COUNTRY: U.S.A.

13. FATHER'S NAME: John Virt

14. MOTHER'S MAIDEN NAME: Margaret Peyton

15. WAS DECEASED IN U.S. ARMED FORCES: No

If yes, give war or dates of service: None

16. SOCIAL SECURITY NUMBER: 521-01-0517

17. INFORMANT: Jim Hepner

MEDICAL CERTIFICATION

18. CAUSE OF DEATH

PART I. DEATH WAS CAUSED BY:

IMMEDIATE CAUSE (a): Cardio respiratory failure

DUE TO (b): old age

DUE TO (c): [blank]

PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED

TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(a):

fractured hip

19. WAS AUTOPSY PERFORMED? No

20a. Accident

20b. DESCRIBE HOW INJURY OCCURRED:

Individual slipped on banana peeling at Vi-Ka-Nel Nursing Home

20c. TIME OF INJURY: 11:40 a.m. 1-16-73

20d. INJURY OCCURRED: NOT WHILE AT WORK

20e. PLACE OF INJURY: Vi-Ka-Nel Nursing Home

20f. CITY, TOWN, OR LOCATION: Harlingen, [COUNTY] Cameron, [STATE] Texas

21. I hereby certify that I attended the deceased from 1-16-73 , 19[blank] to 1-26-73, 19[blank] and last saw the deceased alive on 1-26, 1973. Death occurred at 3:20 p.m. on the date stated above, and to the best of my knowledge, from the causes stated.

22a. SIGNATURE: Martin V. A[illegible], M.D.

22b. ADDRESS: 1622 Ed Carey Drive, Harlingen, Texas

22c. DATE SIGNED: 1/29/73

23a. BURIAL, CREMATION, REMOVAL: Burial

23b. DATE: January 30, 1973

23c. NAME OF CEMETERY OR CREMATORY: Buena Vista Cemetery

23d. LOCATION: Brownsville, Cameron, Texas

24. FUNERAL DIRECTOR'S SIGNATURE: Kreidler-Ashcraft, David L. Tomlinson, #6421

25a. REGISTRAR'S FILE NUMBER: 77

25b. DATE REC'D BY LOCAL REGISTRAR: January 30, 1973

25c. REGISTRAR'S SIGNATURE: Mary Bolado